Clinics in occupational and environmental medicine
-
Clin Occup Environ Med · May 2004
ReviewWorkers' compensation: a historical review and description of a legal and social insurance system.
The workers' compensation system is a no-fault legal and social insurance system established to address compensation issues that involve work-related injuries and illnesses. The system was developed in response to dissatisfaction with common law litigation on the parts of injured workers and employers. The history of the development of workers' compensation is reviewed, and a general description of the system is offered, including discussion of state law and insurance structures, benefits and costs, administrative boards/commissions, and the federal systems for workers' compensation and related programs. The recent history of the workers' compensation system is provided, the recommendations of the National Commission on State Workmen's Compensation Laws in 1972 are reviewed, and the problems and state-initiated changes in worker's compensation that occurred during the 1990s are discussed.
-
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. ⋯ 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.
-
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. ⋯ 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.