Coverage Gaps and Cost-Shifting for Work-Related Injury and Illness: Who Bears the Financial Burden?

2019 ◽  
Vol 77 (3) ◽  
pp. 223-235
Author(s):  
Jeanne M. Sears ◽  
Amy T. Edmonds ◽  
Norma B. Coe
Keyword(s):  
Health Care ◽  
Occupational Injury ◽  
Financial Burden ◽  
Safety Net ◽  
Flow Diagram ◽  
Workers Compensation ◽  
Social Safety Net ◽  
Cost Shifting ◽  
Work Related ◽  
Work Related Injury

The heavy economic burden of work-related injury/illness falls not only on employers and workers’ compensation systems, but increasingly on health care systems, health and disability insurance, social safety net programs, and workers and their families. We present a flow diagram illustrating mechanisms responsible for the financial burden of occupational injury/illness borne by social safety net programs and by workers and their families, due to cost-shifting and gaps in workers’ compensation coverage. This flow diagram depicts various pathways leading to coverage gaps that may shift the burden of occupational injury/illness-related health care and disability costs ultimately to workers, particularly the most socioeconomically vulnerable. We describe existing research and important research gaps linked to specific pathways in the flow diagram. This flow diagram was developed to facilitate more detailed and comprehensive research into the financial burden imposed by work-related injury/illness, in order to focus policy efforts where improvement is most needed.

Impairment Tutorial: Rating Facial Disfigurement After an Injury

1998 ◽  
Vol 3 (4) ◽  
pp. 6-6
Author(s):  
Marc T. Taylor
Keyword(s):  
Current Work ◽  
Workers Compensation ◽  
Loss Of Function ◽  
Facial Disfigurement ◽  
Work Related ◽  
Work Related Injury ◽  
Compensation Claim ◽  
Impairment Ratings

Abstract This article discusses two important cases that involve the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). First, in Vargas v Industrial Com’n of Arizona, a claimant had a pre-existing non–work-related injury to his right knee as well as a work-related injury, and the issue was apportionment of the pre-existing injury. The court held that, under Arizona's statute, the impairment from the pre-existing injury should be subtracted from the current work-related impairment. In the second case, Colorado courts addressed the issue of apportionment in a workers’ compensation claim in which the pre-existing injury was asymptomatic at the time of the work-related injury (Askey v Industrial Claim Appeals Office). In this case, the court held that the worker's benefits should not be reduced to account for an asymptomatic pre-existing condition that could not be rated accurately using the AMA Guides. The AMA Guides bases impairment ratings on anatomic or physiologic loss of function, and if an examinee presents with two or more sequential injuries and calculable impairments, the AMA Guides can be used to apportion between pre-existing and subsequent impairments. Courts often use the AMA Guides to decide statutorily determined benefits and are subject to interpretation by courts and administrative bodies whose interpretations may vary from state to state.

Gaps in Medicare and the Social Safety Net Predict Financial Strain Among Older Canadians With Multiple Sclerosis

2019 ◽  
Vol 31 (2) ◽  
pp. 77-86 ◽  
Author(s):  
Augustine J. Devasahayam ◽  
Elizabeth M. Wallack ◽  
Michelle Ploughman
Keyword(s):  
Multiple Sclerosis ◽  
Private Health Insurance ◽  
Financial Burden ◽  
Social Systems ◽  
High Stress ◽  
Safety Net ◽  
Financial Strain ◽  
Social Safety Net ◽  
The Social ◽  
Physical Impact

Multiple sclerosis (MS) can create significant financial burden, with cost of living rising consistently with increasing age and disability. We aimed to determine the prevalence and predictors of financial strain among a large sample of older Canadians with MS. A binomial logistic regression, which estimates the probability of an event happening (financial strain—yes/no), was performed. Participants were 64.6 ( SD ± 6.2) years old and reported living with MS symptoms 32.8 ( SD ± 9.4) years. In total, 22% of participants experienced financial strain. Predictors of financial strain (from greatest to least) were not having private health insurance, job loss due to MS, having moderate to high stress, greater physical impact of MS, not having home adaptations, not having social support, and living alone. These findings point to insufficiencies in Canada’s health and social systems when it comes to the provision of universal care to those living with disabling neurological chronic illness.

Underreporting of Work-Related Injury or Illness to Workers??? Compensation: Individual and Industry Factors

2006 ◽  
Vol 48 (9) ◽  
pp. 914-922 ◽  
Author(s):  
Z Joyce Fan ◽  
David K. Bonauto ◽  
Michael P. Foley ◽  
Barbara A. Silverstein
Keyword(s):  
Workers Compensation ◽  
Work Related ◽  
Work Related Injury

More than Meets the Eye: Social, Economic, and Emotional Impacts of Work-Related Injury and Illness

2008 ◽  
Vol 18 (3) ◽  
pp. 343-360 ◽  
Author(s):  
Michael B. Lax ◽  
Rosemary Klein
Keyword(s):  
Access To Health Care ◽  
Health Condition ◽  
Injured Workers ◽  
Workers Compensation ◽  
Occupational Illness ◽  
Work Related ◽  
Work Related Injury ◽  
Retirement Funds ◽  
Financial Impacts ◽  
The Impact

The impact of an occupational illness or injury on an injured worker can be severe. This study assessed several dimensions of the impact on a group of 50 injured workers, all patients at an Occupational Health Center. The dimensions assessed included aspects of access to health care, support from treating physicians in obtaining Workers' Compensation benefits, financial impacts, the role of attorneys and “Independent Medical Examiners,” and the impact on mental health. The results showed almost two-thirds of respondents lost their health insurance after diagnosis with a work-related illness or injury, most for more than a year. Many reported that their treating physician did not want to become involved in Workers' Compensation, despite indicating a belief that the health condition was work-related. The financial impacts of a work-related diagnosis were particularly striking, with respondents reporting that they were burdened with both costs directly related to the medical care of their condition, and with coping with ongoing general expenses on a reduced income. Many respondents reported depleting savings, borrowing money, taking out retirement funds, and declaring bankruptcy in efforts to cope. Emotionally, respondents almost universally reported their diagnosis and related issues were associated with depression, anxiety, and loss of identity and self-worth. This study demonstrates how a work-related injury or illness can extend far beyond the physical impact for injured workers. Existing systems fail to adequately compensate or rehabilitate injured workers, leaving them to their own devices to deal with their losses, medical or otherwise.

Literature Review

1997 ◽  
Vol 2 (1) ◽  
pp. 4-8
Author(s):  
James B. Talmage
Keyword(s):  
Workers Compensation ◽  
Body Parts ◽  
Injured Worker ◽  
Disability Benefits ◽  
Fourth Edition ◽  
Permanent Disability ◽  
Work Related ◽  
Work Related Injury ◽  
Whole Person ◽  
Compensation Law

Abstract Evaluating physicians should understand how their impairment evaluations are used, and to these ends Section 1.5 of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, discusses impairment and workers’ compensation. Permanent disability rewards may be paid according to a schedule that associates impairments of certain body parts, functions, or systems (eg, amputation or loss of sight or hearing) with specific awards. Typically, a schedule in the workers’ compensation law equates disability and a maximum number of weeks of benefits, but what occurs when an injured worker has both scheduled and unscheduled injuries? Under Colorado statute, scheduled injuries involve those to the neck, head, torso, and any injury not specifically enumerated in the statutory schedule. Because schedules usually do not cover all conditions following injuries, nonscheduled awards are available and are based on the extent of impairment, the nature of the injury, and the employee's occupation, experience, training, and age. The Colorado Supreme Court ruled that when a work-related injury results in both a scheduled and a nonscheduled injury, the scheduled injury must be converted to a whole person impairment rating and combined with the nonscheduled injury's whole person impairment when calculating permanent disability benefits. In its decision, the court relied heavily on and cited provisions in the AMA Guides.

Cumulative Injury or Disease Claims: An Attempt to Define Employers’ Liability for Workers’ Compensation

1980 ◽  
Vol 6 (1) ◽  
pp. 1-28
Author(s):  
Joseph LaDou ◽  
Lawrence E. Mulryan ◽  
Kevin J. McCarthy
Keyword(s):  
Occupational Stress ◽  
Financial Burden ◽  
Causal Link ◽  
Direct Result ◽  
Workers Compensation ◽  
Work Related ◽  
Compensation Systems ◽  
Stress Injuries ◽  
The Cost ◽  
All Diseases

AbstractThe workers’ compensation systems of several states have been expanded in recent years to include injuries and diseases caused by cumulative injury and occupational stress. This expansion has placed a financial burden on the respective systems, on employers, and on consumers, who ultimately must pay the cost of claims through higher priced products or services. This expansion may not be justified from a social perspective, however; extant medical and sociological evidence is not conclusive as to whether occupational-stress injuries or diseases—such as coronary heart disease, hypertension, stroke, and neuropsychiatric illness—are the direct result of stressful work environments. Using the California workers” compensation system as a model, the authors submit that the underlying premises of liability governing the expanded systems should be reassessed based (1) on economic factors, specifically, the increasing costs of workers’ compensation; (2) on the capacity of the system to process an ever-increasing number of claims; and (3) on the principle on which workers’ compensation systems were established, that of equity between the employer and the employee.On the basis of these three factors, the authors evaluate three legislative approaches to restructuring the expanded system: presumption of compensability, apportionment of liability, and threshold of compensability. The first recognizes that although certain health problems are related to the workplace, the degree of causation is difficult to prove; under this approach, therefore, causation is presumed, and injury compensated, for all diseases and injuries that the system defines as work-related. The second holds that where a causal relationship between the work and the injury can be proved, the employer nevertheless should be responsible only for that portion of the disability actually caused by the workplace. The third directs that the injured employee be compensated only when a direct causal link between the job and the injury or disease can be proved. The authors recommend that legislators implement this third alternative. For one reason, it is feasible economically; for a second, it would not burden the system or increase litigation; for a third, it is equitable to both employees and employers.

scholarly journals Physical Therapists Who Claimed Workers' Compensation: A Qualitative Study

2003 ◽  
Vol 83 (12) ◽  
pp. 1080-1089 ◽  
Author(s):  
Jean E Cromie ◽  
Valma J Robertson ◽  
Margaret O Best
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Physical Therapists ◽  
Compensation System ◽  
Workers Compensation ◽  
Employment Opportunities ◽  
Small Minority ◽  
Work Related ◽  
Work Related Musculoskeletal Disorders ◽  
Compensation Claims

Background and Purpose. Although most physical therapists experience work-related musculoskeletal disorders (WMSDs) at some time, only a small minority claim workers' compensation. This article describes the experiences of a group of therapists with WMSDs who made compensation claims. Methods. Interviews were used to document the experiences of physical therapists who reported that they had changed their career because of WMSDs. Results and Discussion. Therapists described their experiences in negative terms and found dealing with the workers' compensation system frustrating and unpleasant. They encountered attitudes that labeled them as malingerers and felt their credibility was questioned. Conclusions. Physical therapists' experiences of the workers' compensation system were negative, and they were keen to become independent of it. Those who claimed workers' compensation perceived that a compensable claim could limit their employment opportunities, making confidentiality an important issue when treating other health care professionals.

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