Workers’ Compensation in The United States

篇名 Workers' Compensation in The United States
作者 Trevor Bain
刊名 政大勞動學報
期數 200909(25)
出版單位 國立政治大學勞工研究所
起訖頁 115-170

Workers' compensation was the first form of social insurance to develop widely in the United States (US). It is designed to provide cash benefits and medical care when employees suffer work-related injuries, illnesses or a disability related to their work, and survivor benefits to the dependents of workers who deaths result from a work-related incident. In exchange for receiving benefits, workers who receive workers’ compensation are generally not allowed to bring a tort suit against their employers for damages of any kind.

Thomason, Burton and Hyatt (1998) define disability as one possible consequence of an injury or disease. Most immediately a person afflicted by injury or disease suffers an impairment, which is an anatomic or functional abnormality or loss, such as the amputation of a limb, blindness, or lower back sprain. Impairments can result in functional limitations or limitations in physical or mental performance such as walking or climbing.

In turn, functional limitations may lead to disabilities, which refers to the inability to perform various social roles. A distinction can be made between work disability, which represents the loss of earning capacity or the actual loss of earnings, and non-work disability, which represents the effects of functional limitations on other aspects of life such as recreation and the performance of household tasks. While the origin of a disability is an injury or disease, other factors such as educational attainment or the state of the labor market also affect disability.

Thomason, Burton and Hyatt (1998) go on to say that there are at least five sets of actors involved in workers' disability: workers (including potential workers) and their representatives, employers, insurers, medical community, and government.

The workers and their representatives includes persons who may not be currently employed or even in the labor force and they can be further divided into two subgroups; disabled and nondisabled persons. NonWORKERS’ COMPENSATION IN THE UNITED STATES 117 disabled workers, are sympathetic to the problems of the disabled and their needs, are often obvious. They care about workplace health and safety but more typically are focused on other issues such as wages and job security and in recent years, healthcare costs.

Various persons or organizations represent the disabled and they have interests that sometimes differ from those of their clientele. For example, workers seeking compensation for disability sometimes hire attorneys to represent them. However, attorneys who are paid on a contingency fee basis, so that their compensation is based on the size of the judgment, are frequently reluctant to represent disabled claimants seeking compensation from social security programs such as workers’ compensation, because of the lack of potential fees. Other evidence suggests that contingent fees sometimes induce attorneys to settle workers’ compensation claims for amounts that are substantially less than the claimants would receive if claims were adjudicated.

Unions are democratic political institutions that by and large reflect the interests of their members. As previously indicated non-disabled workers, including union members, are often not interested in disability issues or even workplace health and safety but are more concerned about issues like wages and job security. Disabled persons are not likely to be well represented in the union since there are fewer numbers to begin with and since their disability often forces them out of the labor force and consequently off union membership role.

Employers play several roles in the workers’ disability system. Working conditions established by employers directly affect the incidence of work-related injuries and diseases. In addition, firm policies and practices also determine the employment prospects of the disabled as well as their compensation once employed. Employers also provide compensation to disabled workers in the form of disability or health insurance.

Insurers also play a critical role with respect to several aspects of the workers disability system. Insurers are the primary financial intermediaries between employers and workers in the workers’ compensation program as well as in employer-sponsored health insurance and to a lesser extent, disability insurance. Like employers, insurance carriers are motivated by profit and profit depends on their ability to accurately forecast costs associated with the cost of benefits paid by policy holders. Unexpected cost increases, for example, due to an unanticipated shift in the injury distribution can result in insurer losses (Thomason, Burton and Hyatt, 1998).

Then there is the medical community. While the medical community is involved in the pursuit of all goals of the workers’ disability system, its primary role is to act as the systems gate keeper. This means that physicians legitimize patient complaints determining who is disabled and who is not as well as the nature and cause of disability. Physicians determine eligibility for medical treatment as well as compensation and are also significantly involved in establishing the amount of compensation due.

With regard to the role of government, prior to the industrial age, the problems with work disability were considered the responsibility of the family, the church, or the community. However, the breakdown of these institutions during the industrial revolution as well as the increased incidence of occupationally related injury and disease caused government to assume a greater role. Successive legislative initiatives in the United States since the end of the century have produced the vast array of government agencies associated with every aspect of the workers’ disability system. This includes state worker’s compensation agencies, the Social Security Administration (SSA), the Occupational Safety and

Health Administration (OSHA), various state level OSHAs, the federal state vocational rehabilitation program, the Veterans’ Administration, the National Institute for Safety and Heath, the Equal Employment Opportunity Commission, and state insurance commissions.

This paper addresses the following aspects of the US workers’compensation system: history, a general description of the system,coverage, benefits, appeals, special funds, the possible impact on safety and experience rating, the effects of unions, the role of health maintenance organizations, a brief review of related federal government programs, and conclusions.

關鍵詞 Workers' Compensation in The United States