Occupational diseases are a major public health concern, with a potentially staggering cost in health care and wage-loss benefits. Conservative estimates are that 6–10% of cancers, and 5–10% of myocardial infarctions, strokes, and transient ischemia are caused by workplace factors. Occupational neurological, psychological, renal, and many other diseases are not even estimated because data are so limited, and so few studies are funded. The majority of individuals with known or suspected occupational disease do not file claims for workers’ compensation benefits. Workers who develop occupational diseases following long latency periods seldom receive the benefits to which they are entitled. Only 1 in 20 severely disabled occupational disease victims receives workers’ compensation benefits. Fewer than 1 in 100 occupational cancer cases ever receive workers’ compensation benefits.

Many states have rewritten their workers’ compensation laws, making it even more difficult for injured workers to receive compensation. A primary interest of state legislatures is to reduce employer costs by limiting worker access to benefits. As an example, states have passed major amendments to workers’ compensation laws to reduce benefits by placing limits on compensability. These restrictions included limiting the compensability of two conditions potentially likely to incur large treatment costs, repetitive trauma disorders and mental disabilities. Injuries caused by repetitive trauma, such as carpal tunnel syndrome and noise-induced hearing loss, were restricted by procedural and evidentiary changes that made it more difficult to prove compensability.

Moreover, many states now exclude availability of benefits for occupational stress claims. Fifteen states have simply ruled that stress claims are not compensable unless they are accompanied by a physical injury. Other states exclude stress claims when they are related to personnel actions, or they limit their consideration of claims to situations involving extraordinary or unusual circumstances. The burden of proof for these claims may require that employment be the predominant cause of injury or that claims be proved by a preponderance of evidence. Other amendments limit compensation for the aggravation of preexisting conditions or conditions related to aging. 

Workers’ compensation fails to compensate most occupational injuries and illnesses, including fatalities. Even when applications for benefits are successful, workers’ compensation payments replace only small portions of their lost earnings. After workers’ compensation payments expire, injured workers on average never achieve the earning potential that they had before injury. 

The need for comprehensive reform is urgent. In 2006, I proposed the Public Health Model to address the deficiencies in the workers’ compensation system. The Public Health Model requires that the United States abolish the entire workers’ compensation system, replacing it with a comprehensive disability insurance system for all injuries and illnesses. The objective is to insure everyone equitably and to abolish the government agencies that have failed to do this over the past century. Industry and labor would deal directly with government agencies to determine a national set of benefits for injured or ill workers, with uniform incentives to return to work. Wage replacement for workers ought to be provided for a period of time stipulated by government and consistent with other social programs.

The Public Health Model (further expanded upon here) stipulates the following objectives:

• The current federal and state workers’ compensation systems should be discontinued in favor of a national program with uniform coverage of health care and loss-of-earnings benefits. Workers in private employment should receive the same benefits as government workers.
• Resumption of tort liability should end exclusive remedy and all other provisions of the various state workers’ compensation programs.
• The replacement will be a no-fault compensation system based on disability rather than cause, with an integrated approach to disability compensation such as exists in The Netherlands, where all employees are covered by a compulsory scheme that insures against loss of earnings resulting from long-term disability from any injury or disease. Another working model is the program in New Zealand which provides compensation for all victims of injury by accident, regardless of the cause of the accident.
• Disability should be defined and benefits administered without the need for health care professionals.
• Social Security (SSDI) disability benefits should be provided for all permanent injuries and illnesses. This uniform national coverage should provide an income at a level to support a dignified standard of living during disability.
• Health care should be provided by a national health care system independent of industry involvement and insurance industry control. Workers should receive the same medical care under the same conditions as all other citizens.
• Tort liability for negligence should be imposed on those who knowingly cause disability. There should be industry-wide shared liability for disability caused by or connected to industry, and society-wide shared liability for disability whose cause cannot be identified.
 

The workers’ compensation system pays for less than one third of the total cost of occupational injury and illness in the United States. It evades or shifts most of these costs to individual workers, their families, private medical insurance, and taxpayers through Medicare and Medicaid. The Social Security System now serves as the primary source for insurance for workplace disabilities. Occupational diseases should be covered by workers’ compensation, but their costs are largely evaded by state agencies and private insurers by amending state laws or by cost shifting. These maneuvers may compromise the coverage of millions of disabled workers if Social Security disability benefits are subject to revision or discontinued in the future. The current workers’ compensation system should be discontinued in favor of a national program with uniform coverage of health care and wage loss benefits.

Joe LaDou is currently working on the fifth edition of his textbook on occupational and environmental health.

Further reading:

LaDou J. Workers’ Compensation Reform. Int J Occup Environ Health. 2012;18(2):92-95.

Leigh JP: Economic burden of occupational injury and illness in the United States. Milbank Q 2011;89:728-772.

Leigh JP, Marcin JP. Workers’ compensation benefits and shifting costs for occupational injury and illness. J Occup Environ Med. 2012;54(4):445-450. O’Leary P, Boden LI, Seabury SA, Ozonoff A, Scherer E. Workplace injuries and the take-up of Social Security disability benefits. Soc Secur Bull. 2012;72(3):1-17.