Workers' compensation (which formerly was known as workmen's compensation until the name was changed to make it gender neutral) in the United States is a primarily state-based [1] system of workers' compensation.
In the United States, some form of workers compensation is typically compulsory for almost all employers in most states (depending upon the features of the organization), with the notable exception of Texas as of 2018. [2] Regardless of compulsory requirements, businesses may purchase insurance voluntarily, and in the United States policies typically include Part One for compulsory coverage and Part Two for non-compulsory coverage. [3]
By 1949, every state had enacted a workers' compensation program. [4]
The Workers' Accident Insurance system put into place by Otto von Bismarck in Germany in 1884 is often cited as a model for the rest of Europe and later the United States. [5] In the late 19th and early 20th century, U.S. policymakers, journalists, and social scientists convinced of the need for a compensation law disagreed over whether the United States should follow the German system or the British system. The German system was based on insurance and removed employees' right to sue, while the British system preserved the right to sue. The United States eventually followed the German example. [6] Prior to compensation laws, the United States dealt with employee injuries entirely through litigation. The law made an "unholy trinity" of tort defenses available to employers, including contributory negligence, assumption of risk, and the fellow servant rule. [7] As result of this trio of legal doctrines, employees injured in accidents or the families of workers killed at work often lost lawsuits over workplace injuries. [8]
In 1855, Georgia and Alabama passed Employer Liability Acts; 26 other states passed similar acts between 1855 and 1907. [9] Early laws permitted injured employees to sue the employer and then prove a negligent act or omission. [10] [11] (A similar scheme was set forth in Britain's 1880 Act. [12] )
Statewide workers' compensation laws were passed in New York in 1898, Maryland in 1902, Massachusetts in 1908, and Montana in 1909. The first law covering federal employees was passed in 1906. [13] (See: FELA, 1908; FECA, 1916; Kern, 1918.) These laws were later struck down in the courts as unconstitutional, including a 1910 New York law that was declared unconstitutional on March 24, 1911, one day before the Triangle Shirtwaist Factory Fire. [14] In 1911, Wisconsin became the first state to pass a comprehensive law that was not successfully challenged in the courts. [10] By 1949, every state had enacted a workers' compensation program. [15]
In the early 20th century workers' compensation laws varied between states in the degree to which they were voluntary or required. In some states, employers were forced to become liable for the costs of employees' injuries. In other states, employers could choose whether or not to fall under compensation laws. [16] In still other states, employers had the choice whether to fall under compensation laws, but if they chose not to they ran greater risks of employee injury lawsuits. [17] In some states, employers argued in court that compulsory participation laws were unconstitutional and violated the 14th amendment, which required due process before a person or entity could be deprived of property. [18] In 1917 the issue of due process was resolved by the United States Supreme Court in New York Central Railway Co. v. White which held that an employer's due process rights were not impeded by mandatory workers' compensation. [19] Following this ruling, each state instituted different threshold requirements. The adoption of the workers' compensation laws led to changes in how workplace accidents are compensated. Compensation is no longer based on the worker showing that the employer was at fault, nor can compensation be denied if the worker's negligence contributes to the injury. [20] Nearly all employers are required to have insurance to cover payments for: (1) medical costs resulting from occupational injuries and some occupational illnesses suffered by workers; and (2) partial replacement of injured or ill workers' lost wages, also known as indemnity. [21] One unfortunate side effect of compensation laws in their early days was to create incentives for employers to fire or refuse to hire employees with disabilities or health conditions that made them more expensive to injure, such as a person with only one eye. [22]
In the United States, most employees who are injured on the job receive medical care responsive to the workplace injury, and, in some cases, payment to compensate for resulting disabilities. [23] Generally, an injury that occurs when an employee is on their way to or from work does not qualify for workers' compensation benefits; however, there are some exceptions if your responsibilities demand that you be in multiple locations, or stay in the course of your employment after work hours. [24]
There are two methods by which an employer can comply with its obligation to provide workers' compensation coverage for its employees. Very large organizations and governments may choose to "self-insure" in which the organization obtains permission from the workers' compensation agency to pay claims directly, without being required to carry insurance.
Smaller organizations must, and self-insured organizations may, purchase a workers' compensation insurance policy to cover obligations for work-related injuries to employees. [25] Some self-insured organizations will use a "hybrid" approach, hiring an insurance company to investigate workers' compensation claims, but paying the claims itself out of its own pockets.
Note that being self-insured is not the same as being uninsured. A self-insured organization has permission from a state agency to not carry workers' compensation insurance, generally because the organization is large enough and has enough assets to cover claims on its own. In almost all States, having employees without either being authorized to self-insure or carrying workers' compensation insurance is a serious crime, punishable by fines and imprisonment.
Insurance policies are available to employers through commercial insurance companies: if the employer is deemed an excessive risk to insure at market rates, it can obtain coverage through an assigned-risk program. [26] In many states, there are public uninsured employer funds to pay benefits to workers employed by companies who illegally fail to purchase insurance.[ citation needed ]
Various organizations focus resources on providing education and guidance to workers' compensation administrators and adjudicators in various state and national workers' compensation systems. These include the American Bar Association (ABA), the International Association of Industrial Accident Boards and Commissions (IAIABC), [27] the National Association of Workers' Compensation Judiciary (NAWCJ), [28] and the Workers Compensation Research Institute. [29]
In the United States, according to the Bureau of Labor Statistics' 2010 National Compensation Survey, workers' compensation costs represented 1.6% of employer spending overall, although rates varied significantly across industry sectors. For instance, workers' compensation accounted for 4.4% of employer spending in the construction industry, 1.8% in manufacturing and 1.3% in services. [30]
Clinical outcomes for patients with workers' compensation tend to be worse compared to those non-workers' compensation patients among those undergoing upper extremity surgeries, and have found they tend to take longer to return to their jobs and tend to return to work at lower rates. Factors that might explain this outcome include this patient population having strenuous upper extremity physical demands, and a possible financial gain from reporting significant post-operative disability. [31]
As each state within the United States has its own workers' compensation laws, the circumstances under which workers' compensation is available to workers, the amount of benefits that a worker may receive, and the duration of the benefits paid to an injured worker, vary by state. The workers' compensation system is administered on a state-by-state basis, with a state governing board overseeing varying public/private combinations of workers' compensation systems. [32] The names of such governing boards, or "quasi-judicial agencies", vary from state to state, many being designated as "workers' compensation commissions". In North Carolina, the state entity responsible for administering the workers' compensation system is referred to as the North Carolina Industrial Commission. [33] In Michigan, the Workers' Disability Compensation Agency administers Michigan's Workers' Disability Compensation Act, which provides benefits to cover medical expenses and lost wages for workers who suffer injuries on the job. [34]
In a majority of states, workers' compensation is solely provided by private insurance companies. [35] Twelve states operate state funds (that serve as models to private insurers and insures state employees), and a handful of states have state-owned monopoly insurance providers. [36] To keep state funds from crowding out private insurers, the state funds may be required to act as assigned-risk programs or insurers of last resort for businesses that cannot obtain coverage from a private insurer. [37] In contrast, private insurers can turn away the worst risks and may also write comprehensive insurance packages covering general liability, natural disasters, and other forms of insurance coverage. [38] Of the twelve state funds, the largest is California's State Compensation Insurance Fund.
Underreporting of injuries is a significant problem in the workers' compensation system. [39] Workers, fearing retaliation from their employers, may avoid reporting injuries incurred on the job and instead seek treatment privately, bearing the cost themselves or passing these costs on to their health insurance provider—an element in the increasing cost of health insurance nationwide. [40]
Typically, workers can only receive compensation for injuries received while on the job, but in some states there are exceptions: traveling salespersons and similar employees can be covered if they are injured while taking a work-related trip, employees who are sent on special errands can receive compensation for injuries received on those errands. [41] In some cases workers who, though not currently working, suffer injuries while on the premises of the employer can also receive compensation. [42]
In all states except Georgia and Mississippi, it is illegal for an employer to terminate or refuse to hire an employee for having reported a workplace injury or filed a workers' compensation claim. [43] However, it is often not easy to prove discrimination on the basis of the employee's claims history.[ citation needed ] To abate discrimination of this type, some states have created a "subsequent injury trust fund" which will reimburse insurers for benefits paid to workers who suffer aggravation or recurrence of a compensable injury.[ citation needed ] It is also suggested that laws should be made to prohibit inclusion of claims history in databases or to make it anonymous.[ citation needed ] (See privacy laws.)
Although workers' compensation statutes generally make the employer completely immune from any liability (such as for negligence) above the amount provided by the workers' compensation statutory framework, there are exceptions. In some states, like New Jersey, an employer can still be held liable for larger amounts if the employee proves the employer intentionally caused the harm, [44] while in other states, like Pennsylvania, [45] the employer is immune in all circumstances, but other entities involved in causing the injury, like subcontractors or product manufacturers, may still be held liable. In most scenarios, workers' comp laws in California prevent employees from suing their employers for work-related injuries. [46]
If a workers' compensation claim is denied, for example because an employer or employee fail to follow proper procedures when reporting the injury or if the insurance company does not believe the claim, the injured worker may appeal the denial. [47] [48] In most states, workers compensation claims are handled by administrative law judges or magistrates, who often act as triers of fact. [49] In some states, the injured worker (or their attorney) will also have the option of settling or redeeming their workers' compensation claim, accepting a lump sum in exchange for relinquishing their right to further benefits.In Florida, undocumented workers may appeal after being denied workers' compensation, because Florida law specifies that undocumented workers are still entitled to workers' compensation benefits if they are injured while on the job. [50]
According to one 2018 study, 70% of initially-denied claims are ultimately paid. [51]
Some employers and insurance companies vigorously contest employee claims for workers' compensation payments.[ citation needed ] Injured workers may be able to get help with their claims from state agencies or by retaining a workers' compensation lawyer. [52] Laws in many states limit a claimant's legal expenses to a certain fraction of an award; such "contingency fees" are payable only if the recovery is successful. In some states this fee can be as high as 40% or as little as 11% of the monetary award recovered, if any.
In the vast majority of states, original jurisdiction over workers' compensation disputes has been transferred by statute from the trial courts to special administrative agencies. [53] Within such agencies, disputes are usually handled informally by administrative law judges. Appeals may be taken to an appeals board and from there into the state court system. However, such appeals are difficult and are regarded skeptically by most state appellate courts, because the point of workers' compensation was to reduce litigation. A few states still allow the employee to initiate a lawsuit in a trial court against the employer. For example, Ohio allows appeals to go before a jury. [54]
In California, the Article XIV section 4 of the California Constitution, sets forth the intent of the people to establish a system of workers' compensation. [55] [56]
Texas is unusual in that it allows employers to opt out of the workers' compensation system, with those employers who do not purchase workers' compensation insurance being called non-subscribers. [57] However, those employers are exposed to legal liability in the event of employee injury. The employee must demonstrate that employer negligence caused the injury; if the employer does not subscribe to workers' compensation, the employer loses their common law defense of contributory negligence, assumption of the risk, and the fellow employee doctrine. [58] If successful, the employee can recover their full common law damages, which are more generous than workers' compensation benefits.
In 1995, 44% of Texas employers were non-subscribers, while in 2001 the percentage was estimated to be 35%. [57] The industry advocacy group Texas Association of Business Nonsubscription claims that non-subscribing employers have had greater satisfaction ratings and reduced expenses when compared to employers enrolled in the workers' compensation system. [59] A research survey by Texas's Research and Oversight Council on Workers' Compensation found that 68% of non-subscribing employers and 60% of subscribing employers—a majority in both cases—were satisfied with their experiences in the system, and that satisfaction with non-subscription increased with the size of the firm; but it stated that further research was needed to gauge satisfaction among employees and to determine the adequacy of compensation under non-subscription compared to subscription. [57] In recent years, the Texas Supreme Court has been limiting employer duties to maintain employee safety, limiting the remedies received by injured workers.
In recent years, workers' compensation programs in West Virginia and Nevada were privatised, through mutualisation, in part to resolve situations in which the programs in those states had significantly underfunded their liabilities.[ citation needed ] Only four states rely on entirely state-run programs for workers' compensation: North Dakota, Ohio, Washington, and Wyoming. [60] These four states are referred to as monopolistic states as they require their employers to purchase workers compensation from a government-operated fund. [61] Many other states maintain state-run funds but also allow private insurance companies to insure employers and their employees, as well. [60]
The federal government has its own workers' compensation program, subject to its own requirements and statutory parameters for federal employees.[ citation needed ] The federal government pays its workers' compensation obligations for its own employees through regular appropriations.[ citation needed ]
Employees of common carriers by rail have a statutory remedy under the Federal Employers' Liability Act (FELA), 45 U.S.C. sec. 51, which provides that a carrier "shall be liable" to an employee who is injured by the negligence of the employer. To enforce his compensation rights, the employee may file suit in United States district court or in a state court. The FELA remedy is based on tort principles of ordinary negligence and differs significantly from most state workers' compensation benefit schedules.
Seafarers employed on United States vessels who are injured because of the owner's or the operator's negligence can sue their employers under the Jones Act, 46 U.S.C. App. 688., essentially a remedy very similar to the FELA one.
Dock workers and other maritime workers, who are not seafarers working aboard navigating vessels, are covered by the Federal Longshore and Harbor Workers' Compensation Act, known as US L&H.
Workers' compensation fraud can be committed by doctors, lawyers, employers, insurance company employees and claimants, and may occur in both the private and public sectors. [62]
The topic of workers' compensation fraud is highly controversial, with claimant supporters arguing that fraud by claimants is rare—as low as one-third of one percent, [63] others focusing on the widely reported National Insurance Crime Bureau statistic that workers' compensation fraud accounts for $7.2 billion in unnecessary costs, [64] and government entities acknowledging that "there is no generally accepted method or standard for measuring the extent of workers' compensation fraud ... as a consequence, there are widely divergent opinions about the size of the problem and the relative importance of the issue." [65]
According to the Coalition Against Insurance Fraud, tens of billions of dollars in false claims and unpaid premiums are stolen in the U.S. alone every year. [66]
The most common forms of workers' compensation fraud by workers are:
The most common forms of workers' compensation fraud by employers are:
A tort is a civil wrong that causes a claimant to suffer loss or harm, resulting in legal liability for the person who commits the tortious act. Tort law can be contrasted with criminal law, which deals with criminal wrongs that are punishable by the state. While criminal law aims to punish individuals who commit crimes, tort law aims to compensate individuals who suffer harm as a result of the actions of others. Some wrongful acts, such as assault and battery, can result in both a civil lawsuit and a criminal prosecution in countries where the civil and criminal legal systems are separate. Tort law may also be contrasted with contract law, which provides civil remedies after breach of a duty that arises from a contract. Obligations in both tort and criminal law are more fundamental and are imposed regardless of whether the parties have a contract.
Workers' compensation or workers' comp is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence. The trade-off between assured, limited coverage and lack of recourse outside the worker compensation system is known as "the compensation bargain.” One of the problems that the compensation bargain solved is the problem of employers becoming insolvent as a result of high damage awards. The system of collective liability was created to prevent that and thus to ensure security of compensation to the workers.
A professional employer organisation (PEO) is an outsourcing firm that provides services to small and medium-sized businesses (SMBs). Typically, the PEO offering may include human resource consulting, safety and risk mitigation services, payroll processing, employer payroll tax filing, workers' compensation insurance, health benefits, employers' practice and liability insurance (EPLI), retirement vehicles, regulatory compliance assistance, workforce management technology, and training and development. The PEO enters into a contractual co-employment agreement with its clientele. Through co-employment, the PEO becomes the employer of record (EoR) for tax purposes through filing payroll taxes under its own tax identification numbers. As the legal employer, the PEO is responsible for withholding proper taxes, paying unemployment insurance taxes and providing workers’ compensation coverage.
In its broadest sense, no-fault insurance is any type of insurance contract under which the insured party is indemnified by their own insurance company for losses, regardless of the source of the cause of loss. In this sense, it is similar to first-party coverage. The term "no-fault" is most commonly used in the United States, Australia, and Canada when referring to state or provincial automobile insurance laws where a policyholder and their passengers are reimbursed by the policyholder's own insurance company without proof of fault, and are restricted in their right to seek recovery through the civil-justice system for losses caused by other parties. No-fault insurance has the goal of lowering premium costs by avoiding expensive litigation over the causes of the collision, while providing quick payments for injuries or loss of property.
Liability insurance is a part of the general insurance system of risk financing to protect the purchaser from the risks of liabilities imposed by lawsuits and similar claims and protects the insured if the purchaser is sued for claims that come within the coverage of the insurance policy.
English tort law concerns the compensation for harm to people's rights to health and safety, a clean environment, property, their economic interests, or their reputations. A "tort" is a wrong in civil law, rather than criminal law, that usually requires a payment of money to make up for damage that is caused. Alongside contracts and unjust enrichment, tort law is usually seen as forming one of the three main pillars of the law of obligations.
Personal injury is a legal term for an injury to the body, mind, or emotions, as opposed to an injury to property. In common law jurisdictions the term is most commonly used to refer to a type of tort lawsuit in which the person bringing the suit has suffered harm to their body or mind. Personal injury lawsuits are filed against the person or entity that caused the harm through negligence, gross negligence, reckless conduct, or intentional misconduct, and in some cases on the basis of strict liability. Different jurisdictions describe the damages in different ways, but damages typically include the injured person's medical bills, pain and suffering, and diminished quality of life.
The Workplace Safety and Insurance Board (WSIB) is the workplace compensation board for provincially regulated workplaces in Ontario. As an agency of the Ontario government, the WSIB operates "at arm's length" from the Ministry of Labour, Training and Skills Development and is solely funded by employer premiums, administration fees, and investment revenue. The WSIB is one of the largest compensation boards in North America and is primarily responsible for administering and enforcing the Ontario Workplace Safety and Insurance Act (WSIA).
Tort reform consists of changes in the civil justice system in common law countries that aim to reduce the ability of plaintiffs to bring tort litigation or to reduce damages they can receive. Such changes are generally justified under the grounds that litigation is an inefficient means to compensate plaintiffs; that tort law permits frivolous or otherwise undesirable litigation to crowd the court system; or that the fear of litigation can serve to curtail innovation, raise the cost of consumer goods or insurance premiums for suppliers of services, and increase legal costs for businesses. Tort reform has primarily been prominent in common law jurisdictions, where criticism of judge-made rules regarding tort actions manifests in calls for statutory reform by the legislature.
The Federal Employers' Liability Act (FELA), 45 U.S.C. § 51 et seq. (1908), is a United States federal law that protects and compensates railroaders injured on the job.
The Longshore and Harbor Workers' Compensation Act, 33 U.S.C. §§ 901–950, commonly referred to as the "Longshore Act" or "LHWCA" is federal workers' compensation law/act enacted in 1927. Initially, it mandated coverage to employees injured on navigable waters of the United States. Today, it mandates that coverage be provided to certain "maritime" workers, including most dock workers and maritime workers not otherwise covered by the Jones Act. In addition, Congress has extended the LHWCA to cover non-appropriated fund employees, Outer Continental Shelf workers, and U.S. government contractors working in foreign countries under the Defense Base Act This coverage is mandated for all employees, including owners and officers of companies that work in or around navigable waters of the United States.
The Defense Base Act (DBA) is an extension of the federal workers' compensation program that covers longshoremen and harbor workers, the Longshore and Harbor Workers' Compensation Act 33 U.S.C. §§ 901–950. The DBA covers persons employed at United States defense bases overseas. The DBA is designed to provide medical treatment and compensation to employees of defense contractors injured in the scope and course of employment. The DBA is administered by the United States Department of Labor.
The WorkCover Authority of New South Wales was a New South Wales Government agency established in 1989. The agency created regulations to promote productive, healthy and safe workplaces for workers and employers in New South Wales. The agency formed part of the Safety, Return to Work and Support Division established pursuant to the Safety, Return to Work and Support Board Act, 2012 (NSW).
Farwell v. Boston & Worcester R.R. Corp, 45 Mass. 49, Massachusetts Chief Justice Lemuel Shaw used a contract rationale to prevent a railroad worker from recovering from his employer, Boston and Worcester Railroad, for an injury due to the negligence of a switch tender employed by the same company, even though a third party or passenger would likely have been able to recover for the same injury. Shaw believed that the injured worker was in an equally good—if not better—position to oversee the work of his coworkers than his employer had been. It followed that to allow Farwell to recover compensatory damages would have been to create a moral hazard in the workplace, softening the blow of employee carelessness for those best able to prevent it.
The Virginia Workers' Compensation Commission (VWC) is an agency of the U.S. state of Virginia that oversees the resolution of workers' compensation claims brought in that state, in accordance with the Virginia Workers' Compensation Act. The Commission has exclusive jurisdiction to adjudicate such claims. Its decisions may be appealed to the Virginia Court of Appeals. The Commission is led by a Senior Leadership team consisting of three Commissioners, an Executive Director and a Chief Deputy Commissioner. The Commissioners are appointed by the Virginia General Assembly and serve staggered six-year terms. Honorable Robert A. Rapaport, Honorable Wesley G. Marshall and Honorable R. Ferrell Newman currently serve as Commissioners. The Commissioners elect a Chairman for a term of three years. Commissioner Rapaport currently serves as Chairman. Ms. Evelyn McGill is the Commission’s Executive Director and Honorable James J. Szablewicz is the Commission’s Chief Deputy Commissioner. The Commission is headquartered in Richmond, Virginia, and has offices and hearing locations at various places around the state.
The Workers' Compensation Board of British Columbia, operating as WorkSafeBC, is a statutory agency that was made in 1917, after the provincial legislature put into force legislation passed in 1902. This legislation is known as the Workers Compensation Act.
Uninsured employer in the United States is a term to identify an employer of workers under circumstances where there is no form of insurance in place to provide certain benefits to those workers. More specifically, it is a term used in workers’ compensation law to identify an employer who does not have some form of worker's compensation insurance or self-insurance coverage in effect at the time of, or during the time of, a claimed injury.
The Employers' Liability Act 1880 was an act passed on 7 September 1880 by the Parliament of the United Kingdom. It enabled workers to seek compensation for injuries resulting from the negligence of a fellow employee.
The New York State Insurance Fund (NYSIF) is a governmental insurance carrier that provides workers' compensation and disability benefits for employers in New York State. NYSIF is financially self-supporting and competes with private insurance carriers. It is required by law to provide the lowest possible premiums to maintain its solvency. As of 2015, NYSIF was the largest workers' compensation insurance carrier in New York, with 46% of the market, and that year it earned $2.48 billion in premiums, placing it in the top ten in the United States. On August 21, 2019, the agency launched a rebranding initiative with a new logo.
EML Group is one of the oldest Australian personal injury insurers with history dating back to 1910. The service range of this company is only in Australia, with over 3,500 specialists operating in New South Wales, South Australia and Victoria. The head office of this company is in Sydney. Other branches are distributed in Brisbane in Queensland, Parramatta, Newcastle, Tweed and Gosford in New South Wales, and a South Australian branch in Adelaide.
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