Occupational health nursing interventions to reduce third-party liability in workplace injuries

This article explores general principles of workers' compensation law and the ability to sue third parties for employee injuries by using case law and the treatise Larson's Workers' Compensation Law. This overview provides occupational health nurses with a background on workers' compensation law, who is liable for employee injuries, and how recovery from third parties is distributed between the employer or insurer and the employee. The author then explores interventions that occupational health nurses can implement to reduce employee injury and employer costs for providing workers' compensation. The goal of this article is to stimulate occupational health nurses' critical-thinking and problem-solving skills so they may identify risks and implement cost-effective solutions that will prevent injuries to employees.     

The Workers' Compensation System: Worker friend or foe?

BACKGROUND: The workers' compensation system was designed to help injured workers who have substantial medical expenses and perhaps have lost a great deal of income. This study determines both similarities and differences in how workers experience their interactions with the workers' compensation systems in Florida and Wisconsin. METHODS: Ethnographic open-ended interviews with 204 workers from Florida and 198 workers in Wisconsin were conducted. All the workers had back injuries in 1990 and were either paid workers' compensation temporary disability benefits for at least 4 weeks or received permanent disability benefits or compromise settlements. RESULTS: Some interactions with the workers' compensation system were positive. However, the majority of respondents in both states experienced their encounters with the workers' compensation system as cumbersome, frustrating, and demeaning. CONCLUSIONS: Mistrust, stigmatization, payment delays, and refusal of insurer personnel to pay benefits contribute to workers' negative experiences with the workers' compensation system. These insurer behaviors raise the costs to injured workers of workers' compensation benefits and thus may reduce the propensity of eligible workers to apply for benefits.     

World Trade Organization, ILO conventions, and workers' compensation

The World Trade Organization, the World Bank, and the International Monetary Fund can assist in the implementation of ILO Conventions relating to occupational safety and health in developing countries. Most countries that seek to trade globally receive permission to do so from the WTO. If the WTO required member countries to accept the core ILO Conventions relating to occupational safety and health and workers' compensation, it could accomplish something that has eluded international organizations for decades. International workers' compensation standards are seldom discussed, but may at this time be feasible. Acceptance of a minimum workers' compensation insurance system could be a requirement imposed on applicant nations by WTO member states.     

Workers' compensation costs: still a challenge

The workers' compensation system in the United States, comprised of independent state based and national programs for federal workers, covers approximately 127 million workers and has evolved and grown since its inception in 1911. Coverage has significantly broadened in scope to allow for the inclusion of most occupational injuries and illnesses. The cost of workers' compensation care has also increased. Some of the cost drivers have been identified,and various approaches have been taken to address medical cost containment. There is a need to balance cost control with ensuring benefit adequacy and quality of medical care. It is likely that managing workers' compensation costs will continue to be a challenge in the foreseeable future. The cost of workers' compensation care affects all stakeholders including workers, employers,providers, state workers' compensation regulators, legislatures,and insurers. A continued commitment to quality, accessibility to care, and cost containment, and being alert to emerging issues that can affect these elements, will help ensure that workers are afforded accessible, high quality, and cost-effective care.     

Physical fitness, absenteeism and workers' compensation in smoking and non-smoking police officers

BACKGROUND: Employers seek to minimize business costs by creating conditions of employment. Relying on the presumably negative effects of smoking on variables such as workers' compensation claims, absenteeism and physical fitness scores, they seek a rational basis for requirements that employees refrain from smoking. No research has been found on police officer smoking rates relating to physical fitness, and the resulting economic variables of workers' compensation claims and absenteeism rates. AIMS: To compare police officer non-smoker and smoker physical fitness, absenteeism rates and workers' compensation claims. METHODS: The sample included 514 officers of a metropolitan police department. A physical fitness test was administered. Smoking status, yearly absenteeism rates and workers' compensation claims were collected. RESULTS: Male smokers were significantly older than non-smokers. An analysis of covariance controlling for sex and age indicated that smokers had significantly (P < or = 0.05) lower fitness scores in sit and reach flexibility, sit-ups endurance, bench press strength and bicycle ergometer cardiovascular endurance. When neither age nor sex was controlled in males, a similar trend continued. However, in females only the sit and reach and sit-up tests demonstrated statistically significant differences. Fat percentage, step-test scores, absenteeism rates and workers' compensation claims were not statistically different. CONCLUSION: These data do not provide a rational basis for the requirement that officers refrain from smoking when considering body fat and the economic savings of lower absenteeism rates and workers' compensation. To some extent, smoking policies can be justified by officers' physical fitness but there are age, gender and test protocol considerations.     

Occupational disease and workers' compensation: coverage, costs, and consequences

Most of the costs of occupational disease are not covered by workers' compensation. First, the authors estimated the deaths and costs for all occupational disease in 1999, using epidemiological studies. Among the greatest contributors were job-related cancer, chronic respiratory disease, and circulatory disease. Second, the authors estimated the number of workers' compensation cases, costs, and deaths for 1999, using data from up to 16 states representing all regions of the country. Unlike the epidemiological studies that emphasized fatal diseases, the workers' compensation estimates emphasized nonfatal diseases and conditions like tendonitis and hernia. Comparisons of the epidemiological and workers' compensation estimates suggest that in 1999, workers' compensation missed roughly 46,000 to 93,000 deaths and 8 billion US dollars to 23 billion US dollars in medical costs. These deaths and costs represented substantial cost shifting from workers' compensation systems to individual workers, their families, private medical insurance, and taxpayers (through Medicare and Medicaid). Designing policies to reduce the cost shifting and its associated inefficiency will be challenging.     

Occupational medicine: the case for reform

The specialty of occupational medicine is in peril, in large part because of its reliance on financing by industry, which has powerful incentives to limit costs and to favor physicians who are useful to their employers. Occupational physicians generally practice within the framework of the workers' compensation system. Serious flaws in the incentive structure of workers' compensation constrain objectivity in their practice. Under present law they are unavoidably subject to perverse influences from employers and insurance companies. A fundamental reform of workers' compensation law and practice is urgently needed to separate occupational physicians from the control of employers and workers' compensation insurers, whose interests should not be allowed to override the physicians' integrity or to compromise the specialty.     

The relationship of workers' compensation to the Americans with Disabilities Act and Family and Medical Leave Act

This article examines the intersection of workers' compensation laws with the Americans with Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA). Much ADA and FMLA litigation stems from work-related injuries or illnesses. Knowledge of the ADA and FMLA may help prevent workers' compensation cases from resulting in costly employment litigation. Employees who are absent from work for a work-related condition often have rights under other laws, besides workers' compensation laws, such as the ADA and FMLA. Employers need to be cognizant of this while addressing these cases. First, the goals of state workers' compensation laws and the ADA and FMLA are reviewed. Then specific issues involving the intersection of workers' compensation, ADA,and FMLA are discussed.     

Workers' compensation fraud and the physician

Some individuals in the health care system base their actions primarily on individual economic incentives rather than ethical and societal standards. These actions are considered fraudulent when they can be proven to have violated specific laws or statutes and can impact workers' compensation costs. Physicians and other health care providers involved in the management of workers' compensation claims may have little ability to affect employer or insurer fraud. Ethical and efficient practice style, in conjunction with the maintenance of clarity and objectivity in the evaluation of patient symptoms, can help to reduce the degree to which provider and patient fraud is allowed to develop and flourish. In understanding the factors that promote fraudulent behavior and being able to recognize and manage such behavior, health care providers may impact the perpetuation of fraud and its impact on the workers' compensation system.     

Injured worker helplessness: Critical relationships and systems level approach for intervention

An appropriate paradigm for explaining the evident problems of motivating the workers' compensation claimant toward occupational recovery may be found in the learned helplessness model. This article examines the critical relationships in the workers' compensation system and the potential for development of the injured worker helplessness within that system. The author offers the learned helplessness model as an alternative framework through which injured worker behavior can be explained and understood. It is suggested that the non-contingent rewards and the uncontrollable dynamics characteristic of workers' compensation systems lead to claimants' learning helplessness. Finally, a total quality managed disability prevention system is offered as the organization's best approach to reducing the likelihood of learned helplessness.     

Work-related burns in Washington State, 1994 to 1998

This article describes an investigation of work-related burns in Washington State during 1994-1998. Workers' compensation data were used to describe the general characteristics of burn injuries, estimate industrial claims rates, and compare nonhospitalized and hospitalized burn cases. The completeness of workers' compensation data as a source for surveillance was evaluated. During 1994-1998, a total of 20,213 burn claims were accepted by the workers' compensation system. Hospitalized burn cases represented only 1.5% of burn claims but incurred 55% of the costs. In addition, workers' compensation data underestimated the frequency and rate of burns. Although workers' compensation claims rates decreased during 1994-1998, work-related burns remain a problem in Washington State. Several industries (e.g., roofing, foundries, and aluminum smelting) were identified as priorities for prevention of burn hospitalizations, which incur the greater cost and time loss.     

Methodologic issues in the use of workers' compensation databases for the study of work injuries with days away from work. I. Sensitivity of case ascertainment

BACKGROUND: Case ascertainment costs vary substantially between primary and secondary data sources. This review summarizes information on the sensitivity of state administrative databases in workers' compensation systems for the ascertainment of days-away-from-work (DAFW) work injuries for use in modeling studies. METHODS: Review of the literature supplemented by data from governmental or organizational reports or produced for this report. RESULTS: Employers currently appear to provide workers' compensation insurance coverage for 98.9% of wage and salary workers. Wage and salary jobs account for approximately 90% of jobs in the United States. In industries such as manufacturing, the fraction of covered jobs is probably closer to 98%. In Minnesota, the number of DAFW cases ascertained by the Bureau of Labor Statistics' annual survey of occupational injuries and illnesses is approximately 92-97% concordant with the number of wage compensation claims for injuries producing DAFW over the period 1992-2000, once adjustments are made to permit direct comparisons of the numbers. The workers' compensation databases provide information for more than 95% of the total DAFW resulting from work injuries. Covariate estimates are unaffected by this less than 5% loss because effects appear dependent on time from injury. CONCLUSIONS: Statewide workers' compensation administrative databases can have substantial utility for epidemiologic study of work injuries with DAFW because of their size, using high sensitivity for case ascertainment as the evaluative criterion.     

Worker's compensation litigation of the upper extremity claim

This article presents an overview of the issues presented to physicians and lawyers in evaluating, treating, litigating, and concluding an upper extremity workers' compensation claim. This analysis includes a review of the unique considerations involved in the workers' compensation patient/claimant, a general examination of workers' compensation law, and the interplay between litigation and the medical management of the patient.     

Workers' compensation reform

Workers' compensation reform efforts respond to the competing interests of business, labor and insurers. Early reforms expanded programs in response to inadequate benefits and coverage while in the 1980s and 1990s states responded to increasing costs by tightening fee schedules, limiting physician choice, restricting eligibility,lowering benefits, and integrating managed care into workers' compensation. Although managed care has resulted in significant medical savings, the cost of workers' compensation is again rapidly increasing in some states, where workers' compensation legislation is again at the center of debate. Increasing the use of treatment guidelines, placing limitations on use of services, developing more objective criteria for determining level of disability, and streamlining dispute resolutions have been offered as solutions. Controlling costs alone, however, cannot solve other problems of workers' compensation. Future reform efforts will need to focus not only on the costs of the system but also its inclusiveness and support of the workers and their families it was intended to protect.     

"Hope in another direction": compensation for work-related illness among women, 1900-1960--Part II

This article examines compensation for work-related illness among women in the first sixty years of the twentieth century. Its first part (Vol. 15, No. 1) discussed women's experience in the employers' liability system and their workers' compensation claims for poisonings. Part II in this issue examines compensation for infectious diseases, principally tuberculosis; litigation involving lung disease produced by beryllium and asbestos; and women's workers' compensation claims for illnesses involving a mental component.     

EDI clears a path for simplifying workers' comp

In an effort to cut costs in the paperchoked workers' compensation insurance system, states, insurers, employers and third-party administrators are testing new electronic data interchange applications. Proponents say EDI will not only reduce administrative costs, but also will speed the flow of information so that workers can receive proper care sooner and return to work faster. Two groups are developing standard electronic formats for workers' compensation transactions to simplify the conversion to EDI.     

"Hope in another direction": compensation for work-related illness among women, 1900-1960--Part I

This two-part article looks at women's attempts to receive compensation for their work-related illnesses in the first sixty years of the twentieth century. Women pressed claims through narrow legal remedies in the tort and workers' compensation systems for a small part of their massive burden of work-related illnesses. Part I examines the network of women advocates around occupational disease compensation; women's experience under the employers' liability and workers' compensation systems; women's most frequently compensated illnesses under workers' compensation, dermatitis and systemic poisoning; and notable litigation episodes involving phosphorus and radium poisoning. Part II of this article, to be published in the next issue, focuses on compensation for tuberculosis, asbestosis, beryllium disease, and illnesses with a mental component.     

Medical costs in workers' compensation insurance: comment

Professors Baker and Krueger ignore some costs associated with workers' compensation. Because of these costs, the contention that physicians willfully exploit the workers' compensation system for their own gain is questioned.     

Barriers to workers' compensation and medical care for injured Personal Assistance Services workers

OBJECTIVES: We documented barriers to workers' compensation and injury-related medical care faced by homecare or Personal Assistance Services (PAS) workers. We explored differences between independent providers and agency-employed workers. METHODS: We conducted in-depth, semi-structured interviews with a diverse sample of 38 injured workers. Participants were primarily female and racial-ethnic minorities. RESULTS: Most participants (82%) were independent providers. Common barriers to reporting injury included commitments to clients and financial pressure. Unlike agency employees, many independent providers knew little about workers' compensation eligibility and injury reporting procedures, and frequently were given "the runaround" by the social service bureaucracy when they attempted to report injury and access injury-related medical care. Among independent providers, delays in filing a claim and receiving timely medical attention were common. CONCLUSIONS: The lack of a traditional employment infrastructure has important implications for vulnerable workers' health and the sustainability of consumer-directed PAS programs. We provide recommendations for improving workers' access to workers' compensation and injury-related medical care.