WORKERS 'COMPENSATION
Major Topics
overview of Workers' Compensation Historical Perspective Workers Compensation Lagislation Modern Workers' Compensation Workers' Compensation Insurance Resolution of Workers' Compensation Disputes Disabilities and Workers' Compensation njuries and Workers' Compensation Monetary Benefits of Workers' Compensation Medical Treatment and Rehabilitation Medical Management of Workplace Injuries Administration. and Case Management
Cost Allocation Problems with Workers' Compensation Spotting Workers' Compensation Fraud and Abuse Future of Workers' Compensation Cost-Reduction Strategies.
- OVERVIEW OF WORKERS 'COMPENSATION
The concept of workers 'compensation developed as a way to allow injured employees to be compensated appropriately without having to take their employer to court The underlying rationale for workers' compensation had two aspects (1) fairness to injured employees, especially those without the resources to. undertake legal actions that are often long. drawn out. and expen-siva: and (2) reduction of costs to employers associated with workplace injuries fog. legal. image. and morale costs), Workers' compensation is.
intended to be a no-fault approach to resolving workplace accidents by reha-bilitating injured employees and minimizing their personal losses because of their reduced ability to perform and in the labor market.1 Since its compete inception as a concept. workers 'compensation has evolved into a system that pays out approximately $ 70 million in benefits and medical costs annually The national average net cost of workers' compensation in the manufacturing sector is almost $ 6 per $ 100 of payroll.
Workers compensation represents a compromise between the needs of employees and the needs of employers. Employees give up their right to seek unlimited compensation for pain and suffering through legal action. Employers award the prescribed compensation (typically through insurance premiums) regardless of the employee's negligence. The theory is that in the long run both employees and employers will benefit more than either would through legal action. As you will see later in this chapter, although workers compensation has reduced the amount of legal action arising out of workplace accidents. it has not completely eliminated legal actions.
- Objectives of Workers' Compensation
Workers' compensation laws are not uniform from state to state. In fact. there are extreme variations. However, regardless of the language contained in the enabling legislation in a specific state. workers' compensation as a concept has several widely accepted objectives: Replacement of income Rehabilitation of the injured employee Prevention of accidents Cost allocation 2 The basic premises underlying these objectives are described in the follow ing paragraphs.
- Replacement of Income
Employees injured on the job lose income if they are unable to work. For this reason. workers' compensation is intended to replace the lost income ade quately and promptly. Adequate income replacement is viewed as replacement of current and future income (minus taxes) at a ratio of two-thirds (in most states). Workers' compensation benefits are required to continue wen if the employer goes out of business.
- Rehabilitation of the Injured Employee
A basic premise of workers' compensation is that the injured worker will return to work in every case possible. although not necessarily in the same job or career field. For this reason. a major objective of workers compensation is to rehabilitate the injured employee. The rehabilitation program is to provide the needed medical care at no cost to the injured employee until he or she is.
pronounced fit to return to work. The program also provides vocational training or retraining as needed. Both components seek to motivate the employee to return to the labor force as soon as possible.
- Accident Prevention
Preventing future accidents is a major objective of workers' compensation. The theory underlying this objective is that employers will invest in accident prevention programs to hold down compensation costs. The payoff to employ-ers comes in the form of lower insurance premiums that result from fewer accidents.
- Cost Allocation
The potential risks associated with different occupations vary. For example, working as a minor is generally considered more hazardous than working as an architect. The underlying principle of cost allocation is to spread the cost of workers' compensation appropriately and proportionately among industries ranging from the most to the least hazardous. The costs of accidents should be allocated in accordance with the.accident history of the industry so that high-risk industries higher workers' compensation insurance premiums than do pay low-risk industries.
- Who is Covered by Workers' Compensation?
Workers' compensation laws are written at the state level. and there are many variations among these laws. As a result. it is difficult to make generalizations. Complicating the issue further is the fact that workers' compensation laws are constantly being amended. revised. and rewritten. Additionally. some states make participation in a workers' compensation program voluntary others excuse employers with fewer than a specified number of employees. In spite of the differences among workers' compensation laws in the various states. approximately 80 percent of the employees in the United States are covered by workers' compensation. Those employees who are not covered or whose coverage is limited vary as the laws vary. However. they can be categorized in general terms as follows: Agricultural employees Domestic employees Casual employees Hazardous work employees Charitable or religious employees Employees of small organizations Railroad and maritime employees Contractors and subcontractors Minors Extraterritorial employees.
According to Hammer, coverage in these types of employment. to the extent there is coverage, varies from state to state as follows: Agricultural employees have limited coverage in 38 states. Puerto Rico and the Virgin Islands. In 15 states, workers compensation coverage for agricultural employees is voluntary. In these states, employers are allowed to provide coverage if they wish but are not required to do so. Domestic employees have coverage available in all 50 states and Puerto Rico. However. coverage tends to be limited and subject to minimum requirements regarding hours worked and earnings. Casual employees are employed in positions in which the work is occa sional. incidental. and scattered at irregular intervals. Such employees are not typically afforded workers' compensation coverage. Hazardous employment is the only type afforded workers' compensation coverage in some states. To qualify. a particular type of employment must be on an approved list of hazardous or especially hazardous jobs. However the trend in these states is to broaden the list of approved jobs Charitable or religious employees are not afforded workers' compensation in most states when this work is irregular, temporary. or short-term small organizations that employ fewer than a stipulated number of employ ees do not fall under the umbrella of workers' compensation in 26 states. Railroad and maritime workers are not typically covered by workers' compensation. However, in most cases, they are covered by the Federal Employer's Liability Act. This act disallows the use of common law defenses by employers if sued by an employee for negligence. Contractors and subcontractors are those who agree to perform a job or ser-vice for an agreed amount of in nondirected. nonsupervised format money a In essence, contract and subcontract employees are viewed as being self-employed. For this they are not covered by workers compensation. reason. Minors are afforded regular workers' compensation coverage as long as they are legally employed. In some states. coverage is significantly higher for minors who are working illegally. Extraterritorial employees are those who work in one state but live in another. In these cases, the employee is usually temporary duty. Such on employees are typically afforded the workers' compensation coverage of their home state.
- HISTORICAL PERSPECTIVE
Before workers' compensation laws were enacted in the United States, injured employees had no way to obtain compensation for their injuries take except to their employer to court. Although common law did require employers to pro vide a safe and healthy work environment. injured employees bore the burden of proof that negligence in the form of unsafe conditions contributed to these injuries. According to the Society of Manufacturing Engineers. prior to passage of workers' compensation. employees often had to sue their employer to receive compensation for injuries resulting from a workplace accident or occupational disease, even when the following circumstances prevailed: The employee was disabled or died as the result of a workplace accident or occupational disease. The injury might have been expected to occur when the risks and hazards of the job were considered. Worker negligence on the part of a fellow worker or the injured employee clearly caused the injury. Proving that an injury was the result of employee negligence was typically too costly, too difficult. and too time consuming to be a realistic avenue of redress for most injured employees. According to Somers and Somers, a New York commission determined that it took from six months to six years for an injured worker's case to work its way through the legal system. Typically injured workers. having lost their ability to generate income, could barely afford to get by. much less pay medical expenses. legal fees. and court costs. Another inhibitor was the fear factor Injured employees who hoped to return to work after recovering were often afraid to file suit because they feared retri-bution by their employer. Employers
WORKERS 'COMPENSATION
Major Topics
overview of Workers' Compensation Historical Perspective Workers Compensation Lagislation Modern Workers' Compensation Workers' Compensation Insurance Resolution of Workers' Compensation Disputes Disabilities and Workers' Compensation njuries and Workers' Compensation Monetary Benefits of Workers' Compensation Medical Treatment and Rehabilitation Medical Management of Workplace Injuries Administration. and Case Management
Cost Allocation Problems with Workers' Compensation Spotting Workers' Compensation Fraud and Abuse Future of Workers' Compensation Cost-Reduction Strategies.
- OVERVIEW OF WORKERS 'COMPENSATION
The concept of workers 'compensation developed as a way to allow injured employees to be compensated appropriately without having to take their employer to court The underlying rationale for workers' compensation had two aspects (1) fairness to injured employees, especially those without the resources to. undertake legal actions that are often long. drawn out. and expen-siva: and (2) reduction of costs to employers associated with workplace injuries fog. legal. image. and morale costs), Workers' compensation is.
intended to be a no-fault approach to resolving workplace accidents by reha-bilitating injured employees and minimizing their personal losses because of their reduced ability to perform and in the labor market.1 Since its compete inception as a concept. workers 'compensation has evolved into a system that pays out approximately $ 70 million in benefits and medical costs annually The national average net cost of workers' compensation in the manufacturing sector is almost $ 6 per $ 100 of payroll.
Workers compensation represents a compromise between the needs of employees and the needs of employers. Employees give up their right to seek unlimited compensation for pain and suffering through legal action. Employers award the prescribed compensation (typically through insurance premiums) regardless of the employee's negligence. The theory is that in the long run both employees and employers will benefit more than either would through legal action. As you will see later in this chapter, although workers compensation has reduced the amount of legal action arising out of workplace accidents. it has not completely eliminated legal actions.
- Objectives of Workers' Compensation
Workers' compensation laws are not uniform from state to state. In fact. there are extreme variations. However, regardless of the language contained in the enabling legislation in a specific state. workers' compensation as a concept has several widely accepted objectives: Replacement of income Rehabilitation of the injured employee Prevention of accidents Cost allocation 2 The basic premises underlying these objectives are described in the follow ing paragraphs.
- Replacement of Income
Employees injured on the job lose income if they are unable to work. For this reason. workers' compensation is intended to replace the lost income ade quately and promptly. Adequate income replacement is viewed as replacement of current and future income (minus taxes) at a ratio of two-thirds (in most states). Workers' compensation benefits are required to continue wen if the employer goes out of business.
- Rehabilitation of the Injured Employee
A basic premise of workers' compensation is that the injured worker will return to work in every case possible. although not necessarily in the same job or career field. For this reason. a major objective of workers compensation is to rehabilitate the injured employee. The rehabilitation program is to provide the needed medical care at no cost to the injured employee until he or she is.
pronounced fit to return to work. The program also provides vocational training or retraining as needed. Both components seek to motivate the employee to return to the labor force as soon as possible.
- Accident Prevention
Preventing future accidents is a major objective of workers' compensation. The theory underlying this objective is that employers will invest in accident prevention programs to hold down compensation costs. The payoff to employ-ers comes in the form of lower insurance premiums that result from fewer accidents.
- Cost Allocation
The potential risks associated with different occupations vary. For example, working as a minor is generally considered more hazardous than working as an architect. The underlying principle of cost allocation is to spread the cost of workers' compensation appropriately and proportionately among industries ranging from the most to the least hazardous. The costs of accidents should be allocated in accordance with the.accident history of the industry so that high-risk industries higher workers' compensation insurance premiums than do pay low-risk industries.
- Who is Covered by Workers' Compensation?
Workers' compensation laws are written at the state level. and there are many variations among these laws. As a result. it is difficult to make generalizations. Complicating the issue further is the fact that workers' compensation laws are constantly being amended. revised. and rewritten. Additionally. some states make participation in a workers' compensation program voluntary others excuse employers with fewer than a specified number of employees. In spite of the differences among workers' compensation laws in the various states. approximately 80 percent of the employees in the United States are covered by workers' compensation. Those employees who are not covered or whose coverage is limited vary as the laws vary. However. they can be categorized in general terms as follows: Agricultural employees Domestic employees Casual employees Hazardous work employees Charitable or religious employees Employees of small organizations Railroad and maritime employees Contractors and subcontractors Minors Extraterritorial employees.
According to Hammer, coverage in these types of employment. to the extent there is coverage, varies from state to state as follows: Agricultural employees have limited coverage in 38 states. Puerto Rico and the Virgin Islands. In 15 states, workers compensation coverage for agricultural employees is voluntary. In these states, employers are allowed to provide coverage if they wish but are not required to do so. Domestic employees have coverage available in all 50 states and Puerto Rico. However. coverage tends to be limited and subject to minimum requirements regarding hours worked and earnings. Casual employees are employed in positions in which the work is occa sional. incidental. and scattered at irregular intervals. Such employees are not typically afforded workers' compensation coverage. Hazardous employment is the only type afforded workers' compensation coverage in some states. To qualify. a particular type of employment must be on an approved list of hazardous or especially hazardous jobs. However the trend in these states is to broaden the list of approved jobs Charitable or religious employees are not afforded workers' compensation in most states when this work is irregular, temporary. or short-term small organizations that employ fewer than a stipulated number of employ ees do not fall under the umbrella of workers' compensation in 26 states. Railroad and maritime workers are not typically covered by workers' compensation. However, in most cases, they are covered by the Federal Employer's Liability Act. This act disallows the use of common law defenses by employers if sued by an employee for negligence. Contractors and subcontractors are those who agree to perform a job or ser-vice for an agreed amount of in nondirected. nonsupervised format money a In essence, contract and subcontract employees are viewed as being self-employed. For this they are not covered by workers compensation. reason. Minors are afforded regular workers' compensation coverage as long as they are legally employed. In some states. coverage is significantly higher for minors who are working illegally. Extraterritorial employees are those who work in one state but live in another. In these cases, the employee is usually temporary duty. Such on employees are typically afforded the workers' compensation coverage of their home state.
- HISTORICAL PERSPECTIVE
Before workers' compensation laws were enacted in the United States, injured employees had no way to obtain compensation for their injuries take except to their employer to court. Although common law did require employers to pro vide a safe and healthy work environment. injured employees bore the burden of proof that negligence in the form of unsafe conditions contributed to these injuries. According to the Society of Manufacturing Engineers. prior to passage of workers' compensation. employees often had to sue their employer to receive compensation for injuries resulting from a workplace accident or occupational disease, even when the following circumstances prevailed: The employee was disabled or died as the result of a workplace accident or occupational disease. The injury might have been expected to occur when the risks and hazards of the job were considered. Worker negligence on the part of a fellow worker or the injured employee clearly caused the injury. Proving that an injury was the result of employee negligence was typically too costly, too difficult. and too time consuming to be a realistic avenue of redress for most injured employees. According to Somers and Somers, a New York commission determined that it took from six months to six years for an injured worker's case to work its way through the legal system. Typically injured workers. having lost their ability to generate income, could barely afford to get by. much less pay medical expenses. legal fees. and court costs. Another inhibitor was the fear factor Injured employees who hoped to return to work after recovering were often afraid to file suit because they feared retri-bution by their employer. Employers
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