Worker's Compensation

Workers' compensation was one of the first social insurance programs to be adopted broadly throughout the United States. Workers' compensation laws were originally adopted by most states between 1911 and 1920 and the programs continue to be administered by state governments today (Fishback 1).
Private business employees, state employees, and federal employees are all entitled to workers' compensation coverage.

There are two kinds of laws that fall under workers' compensation. These laws include federal compensation laws and state compensation laws. Federal statutes are limited to federal employees and workers that are employed within a governmental position. Some of these laws include The Workmen's Compensation Law of the District of Columbia, The Federal Coal Mine Health and Safety Act (Black Lung Benefits Act), The Federal Employees' Compensation Act, Longshoremen's and Harbor Workers' Compensation Act. State compensation laws cover workers who are not covered by federal statues. The federal law mandates that each state set up laws that meet the minimum requirements. If an employer does not purchase workers' compensation insurance from a private insurance company, then they must self insure and have enough cash in reserve to cover the cost of medical care for all workers who may suffer from a work related injury. In addition to worker's compensation protection, statues require that employers have employers' liability insurance as well (Fordney 480, 481).
Under most workers' compensation systems, an injured employee is entitled to several different types of benefits. Medical care, temporary disability, permanent disability, vocational rehabilitation, workers compensation, and death benefits for survivors are the most common types of benefits. The injured party has the right to all reasonable necessary treatment in order to cure or relieve the effects of the injury or occupational sickness. Medical bills, prescriptions, and sometimes round-trip mileage to the hospital are all usually included under medical treatment compensation. A patient might have to use a company doctor under certain workers' compensation plans, but usually only for a maximum of 30 days. After those 30 days, the patient may choose to see a different doctor. When an injury limits a person from working, they are entitled to receive temporary disability benefits. These payments are designed to help support the injured person while they are not receiving full pay and are recovering from the effects of their suffered injury or illness. There are specific maximum and minimum limits to the pay rate, but this normally equals about two-thirds of the employee's average weekly gross pay and is paid out every two weeks. The first temporary disability check is usually sent out after the doctor verifies an inability to work. Permanent disability means that the injured party has lost some ability to compete in the open labor market of uninjured workers. If a worker cannot completely recover from the effects of an injury, he or she may be entitled to a monetary award for his or her permanent disability. How great a limitation the injury places on one's activities determines the amount and rate at which permanent disability is paid. The person's age, occupation, and earnings at the time of injury are some other elements taken into consideration. Vocational rehabilitation is given when an injury prevents an employee to return to their job. A partial income is distributed with vocational rehabilitation. The vocational rehabilitation benefit usually has a maximum monetary limit and may be replaced by an offer of modified or different work from the employer (Workers' Compensation Benefits and Returning to Work). Death benefits are awarded to dependents of employees who are fatally injured. Dependents are entitled to certain benefits, which may include cash payments or burial allowance (Fordney 484).

There are three different types of claims that may be filed under workers' compensation. These claims include nondisability, temporary, and permanent disability. Nondisability claims usually involve a minor type of injury. The patient sees a physician but they are also still able to work. A nondisability claim does not require weekly temporary disability payments. Temporary disability occurs when a worker is injured or becomes ill and they are not able to perform their job duties for a certain amount of time. With a permanent disability claim, the injured person is usually on temporary disability benefits until a conclusion has been made that he or she cannot return to their former job (Fordney 485, 486).

There are several different types of reports that must be submitted when dealing with a workers' compensation case. Most states require the injured worker as well as the employer to submit an initial report of injury. The history of the accident, present complaints, past history, findings on a physical examination, laboratory and x-ray results, diagnosis, recommended treatment, disability, and prognosis are all included on the initial report. There is a time limit of when the form has to be submitted which varies by each state. Copies of the initial report go to the insurance carrier, the state, and the employer. The physician also retains a copy (Fordney, French, and Follis 383, 385). A medical service order authorizes a physician to treat an injured employee. A photocopy of the form is kept in the physician's files and the original copy is attached to the doctor's preliminary report (Fordney 503). After the physician sees the injured person, he or she has to complete and send in a First Treatment Medical Report. The physician is to send in this report as soon as possible. The time limit for submitting this report varies with each state and failure to file the report is considered a misdemeanor crime. Copies of this report go to the insurance carrier as well as the state. The insurance company waits for the physician's report and bill and then issues a payment to the physician. If there is no further treatment or disability, the case can be closed. A supplemental report is used in temporary disability cases. The report is sent to the insurance carrier after 2 to 4 weeks of treatment to give information on the current status of the patient. If there is a change in prognosis, then a detailed progress report is sent to the insurance carrier. These reports must be sent to the insurance carrier after each hospitalization and office visits so the progress of the case can be updated. A final report is the last report to be submitted by a physician. This report is given at the time the patient is discharged (Fordney 504).

Fishback states "Workers' compensation is now one of the cornerstones of our network of social insurance programs. Although many of the modern social insurance programs were proposed at the state level during the 1910's, workers' compensation was the only program to be widely adopted at the time. Unemployment insurance and old-age pension programs later joined the network through federal legislation in the 1930's. All of these programs have faced new challenges, as they have become a central feature of our economic terrain."

References

Fishback, Price. Workers Compensation. Retrieved July 5, 2007, from EH.Net Encyclopedia. Edited by Robert Whaples. Web site: http://eh.net/encyclopedia/article/fishback.
workers.compensation

Fordney, Marilyn. Insurance Handbook for the Medical Office. (2006). St. Louis: Elsevier Inc.

Fordney, Marilyn & Linda French & Joan Johnson. (2004). Administrative Medical Assisting. New York: Delmar Learning.

Workers Compensation Benefits & Returning to Work. (2007) Retrieved July 6, 2007. Web site: http://www.seamanlawfirm.net/CM/FSDP/PracticeCenter
/Personal-Injury/Workers-Compensation.asp?focus=topic&id=2