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Workers' Compensation: Overview and Issues


Introduction
Nearly all workers and employers in the United States are
covered by workers' compensation. When a covered worker
is injured, becomes sick, or dies as a result of his or her
employment, that worker is entitled to full medical
coverage for the injury, cash benefits to replace a portion of
wages lost due to inability to work, and benefits for
surviving family members in case of death. Employers are
responsible for providing workers' compensation benefits
to their workers and generally purchase insurance to cover
these costs. The federal government has only a limited role
in the provision of workers' compensation because most
workers are covered by state laws. Although every state has
a workers' compensation system, there is no federal
mandate that states have workers' compensation, no federal
standards for state programs, and no oversight of state
systems.

Table  I. Total Workers' Compensation   Costs and
Benefits, 201 5

                                         Per $100 in
                      Billions of $   Covered  Payroll

Total Benefits            61.9              0.86
    Medical Benefits
                         31.1               0.43
    Cash Benefits        30.7               0.43
Employer Costs            94.8               1.32
Source: Christopher F. McLaren and Marjorie L. Baldwin, Workers'
Compensation: Benefits, Coverage, and Costs (2015 Data), National
Academy of Social Insurance, October 2017, p. 1.

The   Grand Bargain of Workers'
Compensation
Before the first workers' compensation laws were passed by
Congress in 1908 and the states in 1911, workers were
required to sue their employers for costs associated with
medical care and lost work due to job-related accidents and
illnesses. In addition to the costs of bringing such suits,
workers had to demonstrate that their employers, and not
any third parties or the workers themselves, were
responsible for their injuries. Although employers could
often avoid being held liable for employment-related
injuries, illnesses, or deaths, employers faced uncertainty in
what their costs would be if they lost a case and a single
case could, depending on the damages awarded by the
court, have a catastrophic financial impact on an employer.

Workers' compensation is often referred to as a grand
bargain between workers and employers. Under workers'
compensation, workers receive benefits for covered
injuries, illnesses, and deaths without regard to fault or
liability. In exchange for this coverage, employees are


Updated October 17, 2017


prohibited from suing their employers and workers'
compensation is the exclusive remedy for workplace
injuries, illnesses, and deaths. Employers are protected from
lawsuits but must pay statutorily defined benefits in all
cases. Employers can purchase insurance to mitigate their
financial risk and increase cost predictability.

Workers' Compensation Benefits
Workers' compensation benefits are set by state or federal
law and thus differ among programs. However, all systems
provide for complete medical coverage, at no cost to the
worker, for any treatment of covered injuries and illnesses.
Systems differ on the rights of employees to select
treatment providers. Approximately 75% of all workers'
compensation cases involve only medical benefits with no
time lost from work due to injury or illness.

In addition, all systems provide for limited wage
replacement, usually two-thirds of the pre-injury wage, if an
injury or illness prevents an employee from working. For
certain permanent partial disabilities, such as the loss of a
limb or an eye, a set amount of benefits are paid regardless
of ability to work. Survivors benefits are paid to the family
members  of workers who die on the job and most systems
offer vocational rehabilitation to assist employees' return to
the workplace. Systems differ in the duration of benefit
eligibility with some systems capping lifetime benefits at a
certain amount or number of months and others paying for
the duration of disability or life of the worker.

Federal Workers' Compensation
Programs
Each state operates its own workers' compensation program
and these state programs cover the majority of employees in
the United States. The federal government, through the
Department of Labor, administers the following workers'
compensation programs:

  Federal Employees' Compensation Act (FECA)  for
   federal civilian employees;

  Longshore and Harbor Workers' Compensation  Act
   (LHWCA) for   private-sector longshore workers, and
   through extensions of the LHWCA, overseas
   government contractors, non-appropriated fund
   instrumentality workers, and workers on the Outer
   Continental Shelf;

  Energy Employees  Occupational Illness Compensation
   Program  Act (EEOICPA)  for former public and private-
   sector workers in the atomic weapons and related
   industries; and

  Black Lung Benefits Act for coal miners with coal
   workers' pneumoconiosis (black lung disease).


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