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Workers' compensation (United States)

Workers' compensation (which formerly was known as workmen's compensation until the name was changed to make it gender neutral) in the United States is a primarily state-based[1] system of workers' compensation.

In the United States, some form of workers compensation is typically compulsory for almost all employers in most states (depending upon the features of the organization), with the notable exception of Texas as of 2018.[2] Regardless of compulsory requirements, businesses may purchase insurance voluntarily, and in the United States policies typically include Part One for compulsory coverage and Part Two for non-compulsory coverage.[3]

By 1949, every state had enacted a workers' compensation program.[4]

History

The Workers' Accident Insurance system put into place by Otto von Bismarck in 1884 is often cited as a model for the rest of Europe and later the United States.[5] In the late 19th and early 20th century, U.S. policymakers, journalists, and social scientists convinced of the need for a compensation law disagreed over whether the United States should follow the German system or the British system. The German system was based on insurance and removed employees' right to sue, while the British system preserved the right to sue. The United States eventually followed the German example.[6] Prior to compensation laws, the United States dealt with employee injuries entirely through litigation. The law made an "unholy trinity" of tort defenses available to employers, including contributory negligence, assumption of risk, and the fellow servant rule.[7] As result of this trio of legal doctrines, employees injured in accidents or the families of workers killed at work often lost lawsuits over workplace injuries.[8]

In 1855, Georgia and Alabama passed Employer Liability Acts; 26 other states passed similar acts between 1855 and 1907. Early laws permitted injured employees to sue the employer and then prove a negligent act or omission.[9][10] (A similar scheme was set forth in Britain's 1880 Act.[11])

Statewide workers' compensation laws were passed in New York in 1898, Maryland in 1902, Massachusetts in 1908, and Montana in 1909. The first law covering federal employees was passed in 1906.[12] (See: FELA, 1908; FECA, 1916; Kern, 1918.) These laws were later struck down in the courts as unconstitutional, including a 1910 New York law that was declared unconstitutional on March 24, 1911, one day before the Triangle Shirtwaist Factory Fire.[13] In 1911, Wisconsin became the first state to pass a comprehensive law that was not successfully challenged in the courts.[9] By 1949, every state had enacted a workers' compensation program.[14]

In the early 20th century workers' compensation laws varied between states in the degree to which they were voluntary or required. In some states, employers were forced to become liable for the costs of employees' injuries. In other states, employers could choose whether or not to fall under compensation laws.[15] In still other states, employers had the choice whether to fall under compensation laws, but if they chose not to they ran greater risks of employee injury lawsuits.[16] In some states, employers argued in court that compulsory participation laws were unconstitutional and violated the 14th amendment, which required due process before a person or entity could be deprived of property.[17] In 1917 the issue of due process was resolved by the United States Supreme Court in New York Central Railway Co. v. White which held that an employer's due process rights were not impeded by mandatory workers' compensation.[18] Following this ruling, each state instituted different threshold requirements. The adoption of the workers' compensation laws led to changes in how workplace accidents are compensated. Compensation is no longer based on the worker showing that the employer was at fault, nor can compensation be denied if the worker's negligence contributes to the injury.[19] Nearly all employers are required to have insurance to cover payments for: (1) medical costs resulting from occupational injuries and some occupational illnesses suffered by workers; and (2) partial replacement of injured or ill workers' lost wages, also known as indemnity.[20] One unfortunate side effect of compensation laws in their early days was to create incentives for employers to fire or refuse to hire employees with disabilities or health conditions that made them more expensive to injure, such as a person with only one eye.[21]


Modern practice

 
 
 
 
Types of jobs that involve dangerous tasks. Clockwise from upper left: Oil rig worker, firefighter, crab fisherman, construction worker.

In the United States, most employees who are injured on the job receive medical care responsive to the workplace injury, and, in some cases, payment to compensate for resulting disabilities.[citation needed] Generally, an injury that occurs when an employee is on their way to or from work does not qualify for workers' compensation benefits; however, there are some exceptions if your responsibilities demand that you be in multiple locations, or stay in the course of your employment after work hours.[22]

There are two methods by which an employer can comply with its obligation to provide workers' compensation coverage for its employees. Very large organizations and governments may choose to "self-insure" in which the organization obtains permission from the workers' compensation agency to pay claims directly, without being required to carry insurance.

Smaller organizations must, and self-insured organizations may, purchase a workers' compensation insurance policy to cover obligations for work-related injuries to employees. Some self-insured organizations will use a "hybrid" approach, hiring an insurance company to investigate workers' compensation claims, but paying the claims itself out of its own pockets.

Note that being self-insured is not the same as being uninsured. A self-insured organization has permission from a state agency to not carry workers' compensation insurance, generally because the organization is large enough and has enough assets to cover claims on its own. In almost all States, having employees without either being authorized to self-insure or carrying workers' compensation insurance is a serious crime, punishable by fines and imprisonment.

Insurance policies are available to employers through commercial insurance companies: if the employer is deemed an excessive risk to insure at market rates, it can obtain coverage through an assigned-risk program.[citation needed] In many states, there are public uninsured employer funds to pay benefits to workers employed by companies who illegally fail to purchase insurance.[citation needed]

Various organizations focus resources on providing education and guidance to workers' compensation administrators and adjudicators in various state and national workers' compensation systems. These include the American Bar Association (ABA), the International Association of Industrial Accident Boards and Commissions (IAIABC),[23] the National Association of Workers' Compensation Judiciary (NAWCJ),[24] and the Workers Compensation Research Institute.[25]

In the United States, according to the Bureau of Labor Statistics' 2010 National Compensation Survey, workers' compensation costs represented 1.6% of employer spending overall, although rates varied significantly across industry sectors. For instance, workers' compensation accounted for 4.4% of employer spending in the construction industry, 1.8% in manufacturing and 1.3% in services.[26]

Clinical outcomes for patients with workers' compensation tend to be worse compared to those non-workers' compensation patients among those undergoing upper extremity surgeries, and have found they tend to take longer to return to their jobs and tend to return to work at lower rates. Factors that might explain this outcome include this patient population having strenuous upper extremity physical demands, and a possible financial gain from reporting significant post-operative disability.[27]

State laws

As each state within the United States has its own workers' compensation laws, the circumstances under which workers' compensation is available to workers, the amount of benefits that a worker may receive, and the duration of the benefits paid to an injured worker, vary by state. The workers' compensation system is administered on a state-by-state basis, with a state governing board overseeing varying public/private combinations of workers' compensation systems.[28] The names of such governing boards, or "quasi-judicial agencies", vary from state to state, many being designated as "workers' compensation commissions". In North Carolina, the state entity responsible for administering the workers' compensation system is referred to as the North Carolina Industrial Commission.[29] In Michigan, the Workers' Disability Compensation Agency administers Michigan's Workers' Disability Compensation Act, which provides benefits to cover medical expenses and lost wages for workers who suffer injuries on the job.[30]

In a majority of states, workers' compensation is solely provided by private insurance companies.[31] Twelve states operate state funds (that serve as models to private insurers and insures state employees), and a handful of states have state-owned monopoly insurance providers.[32] To keep state funds from crowding out private insurers, the state funds may be required to act as assigned-risk programs or insurers of last resort for businesses that cannot obtain coverage from a private insurer.[33] In contrast, private insurers can turn away the worst risks and may also write comprehensive insurance packages covering general liability, natural disasters, and other forms of insurance coverage.[34] Of the twelve state funds, the largest is California's State Compensation Insurance Fund.

Reporting

Underreporting of injuries is a significant problem in the workers' compensation system.[35] Workers, fearing retaliation from their employers, may avoid reporting injuries incurred on the job and instead seek treatment privately, bearing the cost themselves or passing these costs on to their health insurance provider—an element in the increasing cost of health insurance nationwide.[36]

Typically, workers can only receive compensation for injuries received while on the job, but in some states there are exceptions: traveling salespersons and similar employees can be covered if they are injured while taking a work-related trip, employees who are sent on special errands can receive compensation for injuries received on those errands.[37] In some cases workers who, though not currently working, suffer injuries while on the premises of the employer can also receive compensation.[38]

In all states except Georgia and Mississippi, it is illegal for an employer to terminate or refuse to hire an employee for having reported a workplace injury or filed a workers' compensation claim.[39] However, it is often not easy to prove discrimination on the basis of the employee's claims history.[citation needed] To abate discrimination of this type, some states have created a "subsequent injury trust fund" which will reimburse insurers for benefits paid to workers who suffer aggravation or recurrence of a compensable injury.[citation needed] It is also suggested that laws should be made to prohibit inclusion of claims history in databases or to make it anonymous.[citation needed] (See privacy laws.)

Employer liability

Although workers' compensation statutes generally make the employer completely immune from any liability (such as for negligence) above the amount provided by the workers' compensation statutory framework, there are exceptions. In some states, like New Jersey, an employer can still be held liable for larger amounts if the employee proves the employer intentionally caused the harm,[40] while in other states, like Pennsylvania,[41] the employer is immune in all circumstances, but other entities involved in causing the injury, like subcontractors or product manufacturers, may still be held liable.

Appeals

If a workers' compensation claim is denied, for example because an employer or employee fail to follow proper procedures when reporting the injury or if the insurance company does not believe the claim, the injured worker may appeal the denial.[42][43] In most states, workers compensation claims are handled by administrative law judges or magistrates, who often act as triers of fact.[44] In some states, the injured worker (or their attorney) will also have the option of settling or redeeming their workers' compensation claim, accepting a lump sum in exchange for relinquishing their right to further benefits.

According to one 2018 study, 70% of initially-denied claims are ultimately paid.[45]

Some employers and insurance companies vigorously contest employee claims for workers' compensation payments.[citation needed] Injured workers may be able to get help with their claims from state agencies or by retaining a workers' compensation lawyer.[46] Laws in many states limit a claimant's legal expenses to a certain fraction of an award; such "contingency fees" are payable only if the recovery is successful. In some states this fee can be as high as 40% or as little as 11% of the monetary award recovered, if any.

In the vast majority of states, original jurisdiction over workers' compensation disputes has been transferred by statute from the trial courts to special administrative agencies.[47] Within such agencies, disputes are usually handled informally by administrative law judges. Appeals may be taken to an appeals board and from there into the state court system. However, such appeals are difficult and are regarded skeptically by most state appellate courts, because the point of workers' compensation was to reduce litigation. A few states still allow the employee to initiate a lawsuit in a trial court against the employer. For example, Ohio allows appeals to go before a jury.[48]

In California, the Article XIV section 4 of the California Constitution, sets forth the intent of the people to establish a system of workers' compensation.[49][50]

Texas

Texas is unusual in that it allows employers to opt out of the workers' compensation system, with those employers who do not purchase workers' compensation insurance being called non-subscribers.[51] However, those employers are exposed to legal liability in the event of employee injury. The employee must demonstrate that employer negligence caused the injury; if the employer does not subscribe to workers' compensation, the employer loses their common law defense of contributory negligence, assumption of the risk, and the fellow employee doctrine.[52] If successful, the employee can recover their full common law damages, which are more generous than workers' compensation benefits.

In 1995, 44% of Texas employers were non-subscribers, while in 2001 the percentage was estimated to be 35%.[51] The industry advocacy group Texas Association of Business Nonsubscription claims that non-subscribing employers have had greater satisfaction ratings and reduced expenses when compared to employers enrolled in the workers' compensation system.[53] A research survey by Texas's Research and Oversight Council on Workers' Compensation found that 68% of non-subscribing employers and 60% of subscribing employers—a majority in both cases—were satisfied with their experiences in the system, and that satisfaction with non-subscription increased with the size of the firm; but it stated that further research was needed to gauge satisfaction among employees and to determine the adequacy of compensation under non-subscription compared to subscription.[51] In recent years, the Texas Supreme Court has been limiting employer duties to maintain employee safety, limiting the remedies received by injured workers.

Privatization

In recent years, workers' compensation programs in West Virginia and Nevada were privatised, through mutualisation, in part to resolve situations in which the programs in those states had significantly underfunded their liabilities.[citation needed] Only four states rely on entirely state-run programs for workers' compensation: North Dakota, Ohio, Washington, and Wyoming.[54] These four states are referred to as monopolistic states as they require their employers to purchase workers compensation from a government-operated fund.[55] Many other states maintain state-run funds but also allow private insurance companies to insure employers and their employees, as well.[54]

Federal laws

The federal government has its own workers' compensation program, subject to its own requirements and statutory parameters for federal employees.[citation needed] The federal government pays its workers' compensation obligations for its own employees through regular appropriations.[citation needed]

Alternate statutory compensation

Employees of common carriers by rail have a statutory remedy under the Federal Employers' Liability Act (FELA), 45 U.S.C. sec. 51, which provides that a carrier "shall be liable" to an employee who is injured by the negligence of the employer. To enforce his compensation rights, the employee may file suit in United States district court or in a state court. The FELA remedy is based on tort principles of ordinary negligence and differs significantly from most state workers' compensation benefit schedules.

Seafarers employed on United States vessels who are injured because of the owner's or the operator's negligence can sue their employers under the Jones Act, 46 U.S.C. App. 688., essentially a remedy very similar to the FELA one.

Dock workers and other maritime workers, who are not seafarers working aboard navigating vessels, are covered by the Federal Longshore and Harbor Workers' Compensation Act, known as US L&H.

Workers' compensation fraud

Workers' compensation fraud can be committed by doctors, lawyers, employers, insurance company employees and claimants, and may occur in both the private and public sectors.[56]

The topic of workers' compensation fraud is highly controversial, with claimant supporters arguing that fraud by claimants is rare—as low as one-third of one percent,[57] others focusing on the widely reported National Insurance Crime Bureau statistic that workers' compensation fraud accounts for $7.2 billion in unnecessary costs,[58] and government entities acknowledging that "there is no generally accepted method or standard for measuring the extent of workers' compensation fraud ... as a consequence, there are widely divergent opinions about the size of the problem and the relative importance of the issue."[59]

According to the Coalition Against Insurance Fraud, tens of billions of dollars in false claims and unpaid premiums are stolen in the U.S. alone every year.[60]

The most common forms of workers' compensation fraud by workers are:

  1. Remote injury. Workers get injured away from work, but say they were hurt on the job so that their workers' compensation policy will cover the medical bills.
  2. Inflating injuries. A worker has a fairly minor job injury, but lies about the magnitude of the injury in order to collect more workers' compensation money and stay away from work longer.
  3. Faking injuries. Workers fabricate an injury that never took place, and claim it for workers' compensation benefits.[61]
  4. Old injury. A worker with an old injury that never quite healed claims it as a recent work injury in order to get medical care covered.
  5. Malingering. A worker stays home by pretending the disability is ongoing when it is actually healed.
  6. Failure to Disclose. A worker knowingly, or unknowingly, makes a false statement or representation about their injury.[62]

The most common forms of workers' compensation fraud by employers are:

  1. Underreporting payroll. An employer reports that workers are paid less than they actually are in order to lower their premiums.
  2. Inflating experience. An employer claims workers are more experienced than they actually are in order to make them seem less risky and therefore less expensive to cover.
  3. Evasion. An employer fails to obtain workers' compensation for their employees when it is required by law. Workers are often deceived into thinking they are covered when they are not.[63]
  4. Through the introduction of "opt-out plans" that are governed by the federal Employee Retirement Income Security Act, or ERISA, which is regulated by the Labor Department. The "opt-out plans" provide lower and fewer payments, make it more difficult to qualify for benefits, control access to doctors and limit independent appeals of benefits decisions.[64]

See also

References

  1. ^ Mary Kati Haupt (2016) "Workers' Compensation Law & the Remedial Waiver," Barry Law Review: Vol. 21 : Iss. 2 , Article 4. Available at: https://lawpublications.barry.edu/barrylrev/vol21/iss2/4
  2. ^ "Workers' Compensation - Texas". twc.texas.gov/.{{cite web}}: CS1 maint: url-status (link)
  3. ^ "Workers Compensation and Employers Liability Policy | Insurance Glossary Definition | IRMI.com". www.irmi.com. Retrieved 2018-11-24.
  4. ^ eh.net Fishback 19 June 2017 at the Wayback Machine Includes extended data tables.
  5. ^ Karmel, Dying to Work: Death and Injury in the American Workplace (2017), 180.
  6. ^ Rodgers, Atlantic Crossings: Social Politics in a Progressive Age (2009), 209-266.
  7. ^ Haupt, Mary Kati (2016). "Workers' Compensation Law & the Remedial Waiver". Barry Law Review. 21 (2).
  8. ^ Holdren, Injury Impoverished: Workplace Accidents, Capitalism, and Law in the Progressive Era (2021)
  9. ^ a b Guyton, Gregory (1999). "A Brief History of Workers' Compensation". The Iowa Orthopaedic Journal. 19: 106–110. PMC 1888620. PMID 10847524.
  10. ^ Google Scholar
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  11. ^ lawphil.net 3 June 2010 at the Wayback Machine
    "The Employers' Liability Act of Alabama, first enacted in 1855 (Civil Code 1907, Ch. 80, sec. 3910), is a substantial, if not an exact copy, of the English Act of 1880."
  12. ^ The Federal Employers Liability Law of 1906 Archived 16 September 2009 at Wikiwix
    The 1906 law was declared unconstitutional by the Supreme Court; re-worked by Congress in 1908
  13. ^ Ives v. South B. R. Co., 201 N.Y. 271
  14. ^ eh.net Fishback 19 June 2017 at the Wayback Machine Includes extended data tables.
  15. ^ eh.net Fishback 19 June 2017 at the Wayback Machine Includes extended data tables. See table one, note D.
  16. ^ "Ernst Freund, "Constitutional Status of Workmen's Compensation," (1912)". Chicago Unbound.
  17. ^ "Workers' Compensation History: The Great Tradeoff!". Insurance Journal. 2015-03-19. Retrieved 2018-11-24.
  18. ^ "New York Cent. R.R. v. White, 243 U.S. 188, 198, 37 S.Ct. 247, 250, 61 L.Ed. 667 (1917)". Google Scholar.
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  20. ^ Utterback, David; Meyers, Alysha; Wurzelbacher, Steven (2014). "Workers' Compensation Insurance: A Primer for Public Health" (PDF). NIOSH. Retrieved 2019-11-22.{{cite web}}: CS1 maint: url-status (link)
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  25. ^ "Workers Compensation Research Institute". WCRI. from the original on 20 April 2017. Retrieved 6 May 2017.
  26. ^ "The Construction Chart Book: The US Construction Industry and Its Workers, Fifth Ed" (PDF). CPWR. (PDF) from the original on 8 April 2014. Retrieved 18 June 2013.
  27. ^ Gruson, KI; Huang, K; Wanich, T; Depalma, AA (February 2013). "Workers' compensation and outcomes of upper extremity surgery". The Journal of the American Academy of Orthopaedic Surgeons. 21 (2): 67–77. doi:10.5435/JAAOS-21-02-67. PMID 23378370. S2CID 20042355.
  28. ^ "State Workers' Compensation Officials | U.S. Department of Labor". www.dol.gov. Retrieved 2021-04-06.
  29. ^ "North Carolina Industrial Commission". State of North Carolina. from the original on 1 May 2017. Retrieved 6 May 2017.
  30. ^ "Labor and Economic Opportunity - Workers' Disability Compensation Agency". www.michigan.gov. Retrieved 2021-04-06.
  31. ^ Carr, Sean P. (17 May 2010). "State Workers' Comp Funds Wary of Shrinking Premiums" (PDF). BestWeek (20). (PDF) from the original on 4 May 2018. Retrieved 6 May 2017.
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  34. ^ Dworsky, Michael. "The Impact on Workers' Compensation Insurance Markets of Allowing the Terrorism Risk Insurance Act to Expire" (PDF). NCCI. NCCI Holdings, Inc. Retrieved 6 May 2017.
  35. ^ Dong; et al. "Injury Underreporting Among Small Establishments in the Construction Industry" (PDF). American Journal of Industrial Medicine, 2011. (PDF) from the original on 21 May 2016. Retrieved 6 May 2017.
  36. ^ Lipscomb, Hector J. (25 Oct 2012). "Safety, incentives, and the reporting of work-related injuries among union carpenters: "You're pretty much screwed if you get hurt at work"". American Journal of Industrial Medicine. 56 (4): 388–389. doi:10.1002/ajim.22128. PMID 23109103.
  37. ^ Bradt, Gene P. (1980). "An Examination of the Arising out of and the in the Course Of Requirements under the Minnesota Workers' Compensation Law". William Mitchell Law Review. 6: 533. Retrieved 26 May 2018.
  38. ^ See, e.g., "Kmart Corp. v. WCAB (Fitzsimmons), 561 Pa. 111, 748 A. 2d 660 (2000)". Google Scholar. Retrieved 26 May 2018.
  39. ^ Sawyers, Bryan (2012). "The Inconvenient Worker–Can Mississippi's Public Policy Exceptions to the Employment-At-Will Doctrine be Expanded to Encompass the Exercise of Workers' Compensation Rights?" (PDF). Mississippi Law Journal. 81 (6): 1563–1596. (PDF) from the original on 19 March 2015. Retrieved 6 May 2017.
  40. ^ "Millison v. E.I. du Pont de Nemours & Co., 101 N.J. 161, 174, 501 A.2d 505 (1985)". Google Scholar. Retrieved 31 August 2017.
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  42. ^ "If Your Claim is Denied". State of Nevada Department of Business & Industry. State of Nevada. from the original on 1 December 2017. Retrieved 23 November 2017.
  43. ^ "Employees' Guide to Appealing A Workers' Compensation Claim Denial". Labor Commission. State of Utah. from the original on 1 December 2017. Retrieved 23 November 2017.
  44. ^ B., Torrey, David (2012). "Master or Chancellor? The Workers' Compensation Judge and Adjudicatory Power". Journal of the National Association of Administrative Law Judiciary. 32 (1). ISSN 0735-0821.
  45. ^ "Nearly 70 Percent of Denied Workers' Comp Claims Are Paid". Risk & Insurance. 2018-06-25. Retrieved 2018-11-24.
  46. ^ "Workers' Compensation Overview". Legal Aid at Work. from the original on 31 August 2017. Retrieved 31 August 2017.
  47. ^ "Social Security Programs in the United States" by DIANE Publishing Company, p.34 books.google.com
  48. ^ See Ohio Rev. Code Section 4123.512.
  49. ^ "California Constitution, Art. XIV, Sec. 4". California Legislative Information. State of California. from the original on 2 February 2017. Retrieved 5 May 2017.
  50. ^ O'Brien, David W. (Oct 1993). California Workers' Compensation Claims & Benefits (9 Spi ed.). Michie Butterworth. ISBN 978-0250472246.
  51. ^ a b c "A Study of Nonsubscription to the Texas Workers' Compensation System". Texas Department of Insurance. State of Texas. from the original on 5 March 2017. Retrieved 6 May 2017.
  52. ^ "Texas Labor Code Sec. 406.033(a)". from the original on 1 July 2012.
  53. ^ "Texas Association of Business Nonsubscription". txbiz.org. from the original on 29 July 2010. Retrieved 4 May 2018.
  54. ^ a b "Workers' Compensation Law - State by State Comparison". NFIB. 9 June 2017. from the original on 1 December 2017. Retrieved 21 November 2017.
  55. ^ Bonner, Marianne. “How to Buy Workers Compensation Insurance in Monopolistic States.” The Balance Small Business, NELP, 20 Nov. 2019, |[1]
  56. ^ "Workers' Compensation Fraud". Los Angeles County District Attorney's Office. from the original on 21 February 2014. Retrieved 7 February 2014.
  57. ^ Cullen, Lisa. "The Myth of Workers' Compensation Fraud". Public Broadcasting System (PBS). from the original on 19 February 2014. Retrieved 7 February 2014.
  58. ^ "Risk Control" (PDF). Travelers Indemnity Company. (PDF) from the original on 2 November 2014.
  59. ^ McBirnie, Thomas J. "Report On The Workers' Compensation Anti-Fraud Program". California Commission on Health and Safety and Workers' Compensation. from the original on 16 March 2014. Retrieved 7 February 2014.
  60. ^ Quiggle, James. "Worker's Compensation Fraud". Coalition Against Insurance Fraud. from the original on 15 January 2013. Retrieved 27 February 2013.
  61. ^ Wertz, Keith (2000). Managing Worker's Compensation: A Guide to Injury Reduction. CRC press. p. 207.
  62. ^ Spellman, Frank (2016). Occupational Safety and Health Simplified for the Industrial Workplace. London, U.K.: Bernan Press. p. 57. ISBN 978-1-59888-809-6.
  63. ^ Oliphant, Keith (2012). Employers' Liability and Workers' Compensation. Walter de Gruyter. p. 482.
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workers, compensation, united, states, workers, compensation, which, formerly, known, workmen, compensation, until, name, changed, make, gender, neutral, united, states, primarily, state, based, system, workers, compensation, united, states, some, form, worker. Workers compensation which formerly was known as workmen s compensation until the name was changed to make it gender neutral in the United States is a primarily state based 1 system of workers compensation In the United States some form of workers compensation is typically compulsory for almost all employers in most states depending upon the features of the organization with the notable exception of Texas as of 2018 2 Regardless of compulsory requirements businesses may purchase insurance voluntarily and in the United States policies typically include Part One for compulsory coverage and Part Two for non compulsory coverage 3 By 1949 every state had enacted a workers compensation program 4 Contents 1 History 2 Modern practice 3 State laws 3 1 Reporting 3 2 Employer liability 3 3 Appeals 3 4 Texas 4 Privatization 5 Federal laws 6 Alternate statutory compensation 7 Workers compensation fraud 8 See also 9 ReferencesHistory EditThe Workers Accident Insurance system put into place by Otto von Bismarck in 1884 is often cited as a model for the rest of Europe and later the United States 5 In the late 19th and early 20th century U S policymakers journalists and social scientists convinced of the need for a compensation law disagreed over whether the United States should follow the German system or the British system The German system was based on insurance and removed employees right to sue while the British system preserved the right to sue The United States eventually followed the German example 6 Prior to compensation laws the United States dealt with employee injuries entirely through litigation The law made an unholy trinity of tort defenses available to employers including contributory negligence assumption of risk and the fellow servant rule 7 As result of this trio of legal doctrines employees injured in accidents or the families of workers killed at work often lost lawsuits over workplace injuries 8 In 1855 Georgia and Alabama passed Employer Liability Acts 26 other states passed similar acts between 1855 and 1907 Early laws permitted injured employees to sue the employer and then prove a negligent act or omission 9 10 A similar scheme was set forth in Britain s 1880 Act 11 Statewide workers compensation laws were passed in New York in 1898 Maryland in 1902 Massachusetts in 1908 and Montana in 1909 The first law covering federal employees was passed in 1906 12 See FELA 1908 FECA 1916 Kern 1918 These laws were later struck down in the courts as unconstitutional including a 1910 New York law that was declared unconstitutional on March 24 1911 one day before the Triangle Shirtwaist Factory Fire 13 In 1911 Wisconsin became the first state to pass a comprehensive law that was not successfully challenged in the courts 9 By 1949 every state had enacted a workers compensation program 14 In the early 20th century workers compensation laws varied between states in the degree to which they were voluntary or required In some states employers were forced to become liable for the costs of employees injuries In other states employers could choose whether or not to fall under compensation laws 15 In still other states employers had the choice whether to fall under compensation laws but if they chose not to they ran greater risks of employee injury lawsuits 16 In some states employers argued in court that compulsory participation laws were unconstitutional and violated the 14th amendment which required due process before a person or entity could be deprived of property 17 In 1917 the issue of due process was resolved by the United States Supreme Court in New York Central Railway Co v White which held that an employer s due process rights were not impeded by mandatory workers compensation 18 Following this ruling each state instituted different threshold requirements The adoption of the workers compensation laws led to changes in how workplace accidents are compensated Compensation is no longer based on the worker showing that the employer was at fault nor can compensation be denied if the worker s negligence contributes to the injury 19 Nearly all employers are required to have insurance to cover payments for 1 medical costs resulting from occupational injuries and some occupational illnesses suffered by workers and 2 partial replacement of injured or ill workers lost wages also known as indemnity 20 One unfortunate side effect of compensation laws in their early days was to create incentives for employers to fire or refuse to hire employees with disabilities or health conditions that made them more expensive to injure such as a person with only one eye 21 Modern practice Edit Types of jobs that involve dangerous tasks Clockwise from upper left Oil rig worker firefighter crab fisherman construction worker In the United States most employees who are injured on the job receive medical care responsive to the workplace injury and in some cases payment to compensate for resulting disabilities citation needed Generally an injury that occurs when an employee is on their way to or from work does not qualify for workers compensation benefits however there are some exceptions if your responsibilities demand that you be in multiple locations or stay in the course of your employment after work hours 22 There are two methods by which an employer can comply with its obligation to provide workers compensation coverage for its employees Very large organizations and governments may choose to self insure in which the organization obtains permission from the workers compensation agency to pay claims directly without being required to carry insurance Smaller organizations must and self insured organizations may purchase a workers compensation insurance policy to cover obligations for work related injuries to employees Some self insured organizations will use a hybrid approach hiring an insurance company to investigate workers compensation claims but paying the claims itself out of its own pockets Note that being self insured is not the same as being uninsured A self insured organization has permission from a state agency to not carry workers compensation insurance generally because the organization is large enough and has enough assets to cover claims on its own In almost all States having employees without either being authorized to self insure or carrying workers compensation insurance is a serious crime punishable by fines and imprisonment Insurance policies are available to employers through commercial insurance companies if the employer is deemed an excessive risk to insure at market rates it can obtain coverage through an assigned risk program citation needed In many states there are public uninsured employer funds to pay benefits to workers employed by companies who illegally fail to purchase insurance citation needed Various organizations focus resources on providing education and guidance to workers compensation administrators and adjudicators in various state and national workers compensation systems These include the American Bar Association ABA the International Association of Industrial Accident Boards and Commissions IAIABC 23 the National Association of Workers Compensation Judiciary NAWCJ 24 and the Workers Compensation Research Institute 25 In the United States according to the Bureau of Labor Statistics 2010 National Compensation Survey workers compensation costs represented 1 6 of employer spending overall although rates varied significantly across industry sectors For instance workers compensation accounted for 4 4 of employer spending in the construction industry 1 8 in manufacturing and 1 3 in services 26 Clinical outcomes for patients with workers compensation tend to be worse compared to those non workers compensation patients among those undergoing upper extremity surgeries and have found they tend to take longer to return to their jobs and tend to return to work at lower rates Factors that might explain this outcome include this patient population having strenuous upper extremity physical demands and a possible financial gain from reporting significant post operative disability 27 State laws EditAs each state within the United States has its own workers compensation laws the circumstances under which workers compensation is available to workers the amount of benefits that a worker may receive and the duration of the benefits paid to an injured worker vary by state The workers compensation system is administered on a state by state basis with a state governing board overseeing varying public private combinations of workers compensation systems 28 The names of such governing boards or quasi judicial agencies vary from state to state many being designated as workers compensation commissions In North Carolina the state entity responsible for administering the workers compensation system is referred to as the North Carolina Industrial Commission 29 In Michigan the Workers Disability Compensation Agency administers Michigan s Workers Disability Compensation Act which provides benefits to cover medical expenses and lost wages for workers who suffer injuries on the job 30 In a majority of states workers compensation is solely provided by private insurance companies 31 Twelve states operate state funds that serve as models to private insurers and insures state employees and a handful of states have state owned monopoly insurance providers 32 To keep state funds from crowding out private insurers the state funds may be required to act as assigned risk programs or insurers of last resort for businesses that cannot obtain coverage from a private insurer 33 In contrast private insurers can turn away the worst risks and may also write comprehensive insurance packages covering general liability natural disasters and other forms of insurance coverage 34 Of the twelve state funds the largest is California s State Compensation Insurance Fund Reporting Edit Underreporting of injuries is a significant problem in the workers compensation system 35 Workers fearing retaliation from their employers may avoid reporting injuries incurred on the job and instead seek treatment privately bearing the cost themselves or passing these costs on to their health insurance provider an element in the increasing cost of health insurance nationwide 36 Typically workers can only receive compensation for injuries received while on the job but in some states there are exceptions traveling salespersons and similar employees can be covered if they are injured while taking a work related trip employees who are sent on special errands can receive compensation for injuries received on those errands 37 In some cases workers who though not currently working suffer injuries while on the premises of the employer can also receive compensation 38 In all states except Georgia and Mississippi it is illegal for an employer to terminate or refuse to hire an employee for having reported a workplace injury or filed a workers compensation claim 39 However it is often not easy to prove discrimination on the basis of the employee s claims history citation needed To abate discrimination of this type some states have created a subsequent injury trust fund which will reimburse insurers for benefits paid to workers who suffer aggravation or recurrence of a compensable injury citation needed It is also suggested that laws should be made to prohibit inclusion of claims history in databases or to make it anonymous citation needed See privacy laws Employer liability Edit Although workers compensation statutes generally make the employer completely immune from any liability such as for negligence above the amount provided by the workers compensation statutory framework there are exceptions In some states like New Jersey an employer can still be held liable for larger amounts if the employee proves the employer intentionally caused the harm 40 while in other states like Pennsylvania 41 the employer is immune in all circumstances but other entities involved in causing the injury like subcontractors or product manufacturers may still be held liable Appeals Edit If a workers compensation claim is denied for example because an employer or employee fail to follow proper procedures when reporting the injury or if the insurance company does not believe the claim the injured worker may appeal the denial 42 43 In most states workers compensation claims are handled by administrative law judges or magistrates who often act as triers of fact 44 In some states the injured worker or their attorney will also have the option of settling or redeeming their workers compensation claim accepting a lump sum in exchange for relinquishing their right to further benefits According to one 2018 study 70 of initially denied claims are ultimately paid 45 Some employers and insurance companies vigorously contest employee claims for workers compensation payments citation needed Injured workers may be able to get help with their claims from state agencies or by retaining a workers compensation lawyer 46 Laws in many states limit a claimant s legal expenses to a certain fraction of an award such contingency fees are payable only if the recovery is successful In some states this fee can be as high as 40 or as little as 11 of the monetary award recovered if any In the vast majority of states original jurisdiction over workers compensation disputes has been transferred by statute from the trial courts to special administrative agencies 47 Within such agencies disputes are usually handled informally by administrative law judges Appeals may be taken to an appeals board and from there into the state court system However such appeals are difficult and are regarded skeptically by most state appellate courts because the point of workers compensation was to reduce litigation A few states still allow the employee to initiate a lawsuit in a trial court against the employer For example Ohio allows appeals to go before a jury 48 In California the Article XIV section 4 of the California Constitution sets forth the intent of the people to establish a system of workers compensation 49 50 Texas Edit Texas is unusual in that it allows employers to opt out of the workers compensation system with those employers who do not purchase workers compensation insurance being called non subscribers 51 However those employers are exposed to legal liability in the event of employee injury The employee must demonstrate that employer negligence caused the injury if the employer does not subscribe to workers compensation the employer loses their common law defense of contributory negligence assumption of the risk and the fellow employee doctrine 52 If successful the employee can recover their full common law damages which are more generous than workers compensation benefits In 1995 44 of Texas employers were non subscribers while in 2001 the percentage was estimated to be 35 51 The industry advocacy group Texas Association of Business Nonsubscription claims that non subscribing employers have had greater satisfaction ratings and reduced expenses when compared to employers enrolled in the workers compensation system 53 A research survey by Texas s Research and Oversight Council on Workers Compensation found that 68 of non subscribing employers and 60 of subscribing employers a majority in both cases were satisfied with their experiences in the system and that satisfaction with non subscription increased with the size of the firm but it stated that further research was needed to gauge satisfaction among employees and to determine the adequacy of compensation under non subscription compared to subscription 51 In recent years the Texas Supreme Court has been limiting employer duties to maintain employee safety limiting the remedies received by injured workers Privatization EditIn recent years workers compensation programs in West Virginia and Nevada were privatised through mutualisation in part to resolve situations in which the programs in those states had significantly underfunded their liabilities citation needed Only four states rely on entirely state run programs for workers compensation North Dakota Ohio Washington and Wyoming 54 These four states are referred to as monopolistic states as they require their employers to purchase workers compensation from a government operated fund 55 Many other states maintain state run funds but also allow private insurance companies to insure employers and their employees as well 54 Federal laws EditSee also Federal Employers Liability Act Federal Employees Compensation Act and Office of Workers Compensation Programs The federal government has its own workers compensation program subject to its own requirements and statutory parameters for federal employees citation needed The federal government pays its workers compensation obligations for its own employees through regular appropriations citation needed Alternate statutory compensation EditEmployees of common carriers by rail have a statutory remedy under the Federal Employers Liability Act FELA 45 U S C sec 51 which provides that a carrier shall be liable to an employee who is injured by the negligence of the employer To enforce his compensation rights the employee may file suit in United States district court or in a state court The FELA remedy is based on tort principles of ordinary negligence and differs significantly from most state workers compensation benefit schedules Seafarers employed on United States vessels who are injured because of the owner s or the operator s negligence can sue their employers under the Jones Act 46 U S C App 688 essentially a remedy very similar to the FELA one Dock workers and other maritime workers who are not seafarers working aboard navigating vessels are covered by the Federal Longshore and Harbor Workers Compensation Act known as US L amp H Workers compensation fraud EditWorkers compensation fraud can be committed by doctors lawyers employers insurance company employees and claimants and may occur in both the private and public sectors 56 The topic of workers compensation fraud is highly controversial with claimant supporters arguing that fraud by claimants is rare as low as one third of one percent 57 others focusing on the widely reported National Insurance Crime Bureau statistic that workers compensation fraud accounts for 7 2 billion in unnecessary costs 58 and government entities acknowledging that there is no generally accepted method or standard for measuring the extent of workers compensation fraud as a consequence there are widely divergent opinions about the size of the problem and the relative importance of the issue 59 According to the Coalition Against Insurance Fraud tens of billions of dollars in false claims and unpaid premiums are stolen in the U S alone every year 60 The most common forms of workers compensation fraud by workers are Remote injury Workers get injured away from work but say they were hurt on the job so that their workers compensation policy will cover the medical bills Inflating injuries A worker has a fairly minor job injury but lies about the magnitude of the injury in order to collect more workers compensation money and stay away from work longer Faking injuries Workers fabricate an injury that never took place and claim it for workers compensation benefits 61 Old injury A worker with an old injury that never quite healed claims it as a recent work injury in order to get medical care covered Malingering A worker stays home by pretending the disability is ongoing when it is actually healed Failure to Disclose A worker knowingly or unknowingly makes a false statement or representation about their injury 62 The most common forms of workers compensation fraud by employers are Underreporting payroll An employer reports that workers are paid less than they actually are in order to lower their premiums Inflating experience An employer claims workers are more experienced than they actually are in order to make them seem less risky and therefore less expensive to cover Evasion An employer fails to obtain workers compensation for their employees when it is required by law Workers are often deceived into thinking they are covered when they are not 63 Through the introduction of opt out plans that are governed by the federal Employee Retirement Income Security Act or ERISA which is regulated by the Labor Department The opt out plans provide lower and fewer payments make it more difficult to qualify for benefits control access to doctors and limit independent appeals of benefits decisions 64 See also EditMarie Moentmann 1900 1974 child survivor of industrial accident Scaffold Law New York References Edit Mary Kati Haupt 2016 Workers Compensation Law amp the Remedial Waiver Barry Law Review Vol 21 Iss 2 Article 4 Available at https lawpublications barry edu barrylrev vol21 iss2 4 Workers Compensation Texas twc texas gov a href Template Cite web html title Template Cite web cite web a CS1 maint url status link Workers Compensation and Employers Liability Policy Insurance Glossary Definition IRMI com www irmi com Retrieved 2018 11 24 eh net Fishback Archived 19 June 2017 at the Wayback Machine Includes extended data tables Karmel Dying to Work Death and Injury in the American Workplace 2017 180 Rodgers Atlantic Crossings Social Politics in a Progressive Age 2009 209 266 Haupt Mary Kati 2016 Workers Compensation Law amp the Remedial Waiver Barry Law Review 21 2 Holdren Injury Impoverished Workplace Accidents Capitalism and Law in the Progressive Era 2021 a b Guyton Gregory 1999 A Brief History of Workers Compensation The Iowa Orthopaedic Journal 19 106 110 PMC 1888620 PMID 10847524 Google Scholarre THE EMPLOYERS LIABILITY CASES 207 U S 463 1908 lawphil net Archived 3 June 2010 at the Wayback Machine The Employers Liability Act of Alabama first enacted in 1855 Civil Code 1907 Ch 80 sec 3910 is a substantial if 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Can Mississippi s Public Policy Exceptions to the Employment At Will Doctrine be Expanded to Encompass the Exercise of Workers Compensation Rights PDF Mississippi Law Journal 81 6 1563 1596 Archived PDF from the original on 19 March 2015 Retrieved 6 May 2017 Millison v E I du Pont de Nemours amp Co 101 N J 161 174 501 A 2d 505 1985 Google Scholar Retrieved 31 August 2017 Pennsylvania Workers Compensation Act PA gov Commonwealth of Pennsylvania Archived from the original on 31 August 2017 Retrieved 31 August 2017 If Your Claim is Denied State of Nevada Department of Business amp Industry State of Nevada Archived from the original on 1 December 2017 Retrieved 23 November 2017 Employees Guide to Appealing A Workers Compensation Claim Denial Labor Commission State of Utah Archived from the original on 1 December 2017 Retrieved 23 November 2017 B Torrey David 2012 Master or Chancellor The Workers Compensation Judge and Adjudicatory Power Journal of the National Association of Administrative Law Judiciary 32 1 ISSN 0735 0821 Nearly 70 Percent of Denied Workers Comp Claims Are Paid Risk amp Insurance 2018 06 25 Retrieved 2018 11 24 Workers Compensation Overview Legal Aid at Work Archived from the original on 31 August 2017 Retrieved 31 August 2017 Social Security Programs in the United States by DIANE Publishing Company p 34 books google com See Ohio Rev Code Section 4123 512 California Constitution Art XIV Sec 4 California Legislative Information State of California Archived from the original on 2 February 2017 Retrieved 5 May 2017 O Brien David W Oct 1993 California Workers Compensation Claims amp Benefits 9 Spi ed Michie Butterworth ISBN 978 0250472246 a b c A Study of Nonsubscription to the Texas Workers Compensation System Texas Department of Insurance State of Texas Archived from the original on 5 March 2017 Retrieved 6 May 2017 Texas Labor Code Sec 406 033 a Archived from the original on 1 July 2012 Texas Association of Business Nonsubscription txbiz org Archived from the original on 29 July 2010 Retrieved 4 May 2018 a b Workers Compensation Law State by State Comparison NFIB 9 June 2017 Archived from the original on 1 December 2017 Retrieved 21 November 2017 Bonner Marianne How to Buy Workers Compensation Insurance in Monopolistic States The Balance Small Business NELP 20 Nov 2019 1 Workers Compensation Fraud Los Angeles County District Attorney s Office Archived from the original on 21 February 2014 Retrieved 7 February 2014 Cullen Lisa The Myth of Workers Compensation Fraud Public Broadcasting System PBS Archived from the original on 19 February 2014 Retrieved 7 February 2014 Risk Control PDF Travelers Indemnity Company Archived PDF from the original on 2 November 2014 McBirnie Thomas J Report On The Workers Compensation Anti Fraud Program California Commission on Health and Safety and Workers Compensation Archived from the original on 16 March 2014 Retrieved 7 February 2014 Quiggle James Worker s Compensation Fraud Coalition Against 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