Achieving Social Objectives, Public Interest in Workers’ Comp

It is generally agreed that workers’ compensation has five primary objectives:

From those interconnected goals come the present day challenges.

“Broad coverage” implies a universal system. It does not mean restricting access based on immigration status, size or type of firm, or whether someone is a temporary or contract employee. Regarding scope, the earliest systems were meant to protect against, and give incentives to control, occupational illnesses of the day: phossy jaw, wrist drop, painters’ colic, boiler makers’ deafness, potters’ palsy, and hatters’ shakes. Broad coverage of injuries and illnesses today includes cumulative trauma disorders, occupational hearing loss, mental stress and emerging occupational diseases.

Before workers’ compensation, work related disability was often the cause of poverty for workers and families. For many today, uncertainty and inadequate compensation still are the norm. “Substantial protection” against interruption of income tests whether society takes care of injured workers. Under the no-fault workers’ compensation system, it is expected that benefits will be timely, adequate and commensurate with prior income, covering permanent and temporary conditions.

Medical care now accounts for a majority of compensation costs in many states. How can society provide high quality medical care and return to work/rehabilitation services? The emergence of universal health care is a positive element. Rather than sorting out financial responsibility when causes of disability are multifactorial, we can instead learn how to work to improve post-disability care. Arguing over causation is a distraction that most other countries now avoid.

Perhaps the primary challenge is occupational health and safety. Most injuries on the job are not accidents; they are the consequence of poor engineering and design, weak controls, scanty training and inadequate supervision.

John Commons, a Wisconsin scholar who promoted the first state mandatory system that survived early 20th Century court challenges, believed in harnessing market incentives to advance social objectives. Finding new strategies to invoke prevention through that pressure may be prudent. Should insurers have a direct responsibility for injury prevention activities? Should we see some workplace injuries as so obviously preventable that there should be criminal penalties?

The most successful systems should not be those that restrict costs by reducing benefits. But how can we achieve cost-efficient delivery of benefits? We should reduce the inefficiencies that come from having separate policies, oversight and adjudication for siloed systems that individually cover short term, long term, work related, and non-work related disabilities and medical costs. We are challenged to consider ways of integrating coverage.

With powerful stakeholders protecting the employers, insurers, attorneys, medical providers and workers, the primary challenge to workers’ compensation may be how to reform in the public interest.

Shor, Ph.D., is with the Office of the Assistant Secretary for Occupational Safety and Health in the U.S. Department of Labor. His contribution is on behalf of the nonprofit National Academy of Social Insurance (www.nasi.org), of which he is a member. This opinion is his own and does not necessarily represent that of OSHA. He may be reached at shor.glenn@dol.gov.