How Can Workers' Compensation Systems Promote Occupational Safety and Health? Stakeholder Views on Policy and Research Priorities

Abstract

Workers' compensation is a state-level social insurance program that provides financial, medical, and rehabilitation benefits to workers who sustain job-related injuries or illnesses. Workers, employers, and other stakeholders involved in workers' compensation systems have long voiced concerns about the extent to which workers' compensation promotes occupational safety and health (OSH) and the well-being of injured workers; government reports and journalistic accounts in recent years have both highlighted perennial issues and documented emerging concerns. Key topic areas highlighted in these accounts include prevention of injury and disability; system coverage, benefit adequacy, and cost spillovers; claim management processes; and occupational health care. Despite the awareness of these issues across stakeholder groups, it is not clear how much consensus there is about which of these challenges to OSH in the workers' compensation system are most pressing, whether there is sufficient evidence to identify best practices, or what structural barriers have prevented policymakers from resolving these challenges.The National Institute for Occupational Safety and Health (NIOSH) requested that RAND explore the beliefs and priorities of key workers' compensation stakeholder groups about system challenges and research priorities that, if addressed, would be most useful for reforming workers' compensation systems to promote OSH and the well-being of workers. RAND conducted a literature scan to identify published criticisms of current workers' compensation systems, focusing on the implications of workers' compensation for worker safety, health, and economic well-being. After producing a compendium of such perspectives, RAND then convened a series of stakeholder conversations with selected representatives from five stakeholder groups. This report describes stakeholder views and attempts to synthesize these perspectives to offer suggestions for research and policy-analysis priorities likely to make workers' compensation policy more effective at promoting the health and well-being of workers.The research reported here was conducted in the RAND Justice Policy Program, which spans both criminal and civil justice system issues with such topics as public safety, effective policing, police-community relations, drug policy and enforcement, corrections policy, use of technology in law enforcement, tort reform, catastrophe and mass-injury compensation, court resourcing, and insurance regulation. Program research is supported by government agencies, foundations, and the private sector.RAND Justice, Infrastructure, and Environment (JIE) conducts research and analysis in civil and criminal justice, infrastructure development and financing, environmental policy, transportation planning and technology, immigration and border protection, public and occupational safety, energy policy, science and innovation policy, space, telecommunications, and trends and implications of artificial intelligence and other computational technologies. iv Questio...

Prognostic Role of Demographic, Injury and Claim Factors in Disabling Pain and Mental Health Conditions 12 Months after Compensable Injury

“…For instance, by enhancing their knowledge of how claim-related procedures can impact client stress and potentially exacerbate pain, psychopathology and disability outcomes, and receiving training in communication skills to attenuate the level of distress or scrutiny claimants feel. Further, schemes may enhance client outcomes by implementing procedures to enable real-time monitoring of claimant symptoms and treatment needs; altering procedures that require the engagement of a lawyer; and improving the efficiency with which claims are handled and services are provided [ 30 , 63 , 64 , 65 ]. Segmentation of claims so that clients with specific needs or complexity profiles are managed by specialist teams or case managers would also be beneficial in enhancing timely support and reducing redundancy.…”

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

“…Programs intended to reduce WC costs may increase financial burden on injured workers, the social safety net, and other payers. This phenomenon has been described for policies and programs focused on (a) enhancing workplace safety (e.g., employer-provided safety incentives that may discourage injury reporting [Dworsky & Broten, 2018; Lipscomb, Nolan, Patterson, Sticca, & Myers, 2013; Pransky, Snyder, Dembe, & Himmelstein, 1999]), (b) reducing WC fraud (e.g., mandatory drug testing before treatment of a work injury or after filing a WC claim, which may discourage injury reporting [U.S. House of Representatives Committee on Education and Labor, 2008]), or (c) limiting moral hazard (e.g., partial rather than full wage replacement [H.…”

“…Cost-shifting occurs when WC pays less than its expected share of these costs—resulting in another entity bearing more of the financial burden. As the financial burden of occupational injury/illness shifts, employers have fewer incentives to ensure safe and healthy workplaces; furthermore, as this burden is externalized, injured workers, their families, taxpayers, and other entities effectively subsidize employers (Dworsky & Broten, 2018; U.S. Department of Labor, 2016).…”

“…Occupational injury/illness places heavy yet largely obscured burdens on workers, employers, health care and insurance systems, and society overall (Leigh, 2011). Workers’ compensation (WC) programs were developed to compensate workers for health care and work disability-related costs of occupational injury/illness through a no-fault insurance system that in turn gave employers immunity from tort litigation, often referred to as the “grand bargain” (Dworsky & Broten, 2018; Spieler & Burton, 2012; U.S. Department of Labor, 2016).…”

Analyzing Workers’ Compensation Claims and Payments Made Using Data from a Large Insurance Provider

“…WC coverage is provided to all or nearly all workers for whom such coverage is required and covers over 90% of the USA wage and salary workers [ 3 ]. Importantly, because of their design and performance, WC systems address a key concern for the National Institute for Occupational Safety and Health given the implications for occupational safety and health and post-injury outcomes [ 4 ].…”