Workers Compensation Nursing CE Course

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Syllabus

Mary W, 43, an RN on a medical-surgical unit for more than 10 years, was assisting with readjusting a patient with severe obesity in bed and felt a twinge in her back.  As the day progressed, her back bothered her more and more, but she did not think much about it as it was her fifth day of work in a row, and she was tired.  The next day, she had difficulty getting out of bed, and was unable to stand up straight or lift anything over two pounds without severe pain.  She was concerned that she had injured her back the day before, and it was more than just a little strain. She went to her primary care provider.  They gave her an anti-inflammatory, instructions to rest her back and apply ice or heat as needed, and told her not to return to work for a week. Mary was instructed to return to see them if her symptoms did not improve in that time.  In a week, the pain was not greatly better, and she still felt that she was unable to work. 

The PCP asked if her employer provided workers’ compensation, but Mary did not know.  They lived in a state that did not require that of her employer, so Mary’s PCP encouraged her to determine whether her employer provided coverage as she was going to need to utilize that resource given the difficulty she was having.  She went to her employer after doing some research on her own to determine what workers’ compensation is and how the system worked. In the meantime, her PCP gave her a prescription for physical therapy treatments and suggested that she remain out of work.

 Workers’ compensation, which was called workmen’s compensation until the name was changed to make it gender-neutral, is a form of accident insurance. It is paid by employers, with no payroll deductions taken out of employees’ earnings for this benefit. It provides coverage for medical expenses to employees injured in the course of employment. This includes those that acquire a work-related illness. If unable to work, workers’ compensation coverage will also pay for lost wages until the employee is able to work again. It is also designed to provide benefits to employees’ dependents if the employee dies as a result of a job-related incident or injury (US Department of Labor, n.d.c). The other side of this benefit is the mandatory agreement by the worker that they may not sue their employer for damages related to negligence if the employee believes that caused the injury.  This agreement is known as “the compensation bargain” which prevents employers from going bankrupt due to high-damage awards, through which juries awarded incredibly high amounts of money to the injured.

Workers’ compensation insurance is a necessary safeguard for people in the workforce today.  It is designed to protect employees from risking their health, safety, and assets for their jobs.  The history of workers’ compensation provides some insight into how this system works and how it protects workers.  When workers were forced to sue for compensation, many lost all they had in legal fees, with the risk of no settlement in the employee’s favor.

There are cases on record of employees who sued their employer and ended up bankrupt because of their injury and the cost of the lawsuit.  There were three legal frameworks that employers used that were successful at winning these lawsuits.  One was contributory negligence, meaning that if the worker was at least partially responsible for their own injury, such as slipping and falling, the employer could not be considered liable. A second method was for the employer to allege that a fellow workman caused the injury to occur, and again the employee would get nothing. A third method was the doctrine of assumption of risk.  This doctrine holds that employees accepted the hazards of their work when they signed their initial employment contracts.  Some companies even required new employees to sign a contract stating that they would not sue if they were injured in the course of their work.  These death contracts are reported to be the stimulus causing Otto von Bismark to champion workers’ accident insurance (Boggs, 2015).

When the workers’ compensation statutes were developed, they protected the workers but also provided protection to the employers, as they could no longer be sued for increased damages over what was awarded for the injury.  Statutes also included a provision for dependents of those workers who were killed in work-related accidents or illnesses. Other portions of the law protected employers and fellow workers by limiting the amount an injured employee can recover from an accident and the liability of other co-workers in most accidents (Boggs, 2015). 

The first workman’s compensation law appears to have been established in 2050 BC in present-day Iraq.  This law outlined compensation for injury to a worker’s specific body parts.  Ancient Roman, Greek, and Chinese laws followed.  Several versions of these laws existed over the years in different countries throughout the rest of history (Guyton, 1999).  The United States version of workers’ compensation was fashioned after the one in Germany begun by Otto von Bismark in 1881  (Boggs, 2015).  Wisconsin was the first state to enact a workers’ compensation law in 1911, with Mississippi becoming the final state to do so in 1948 (Guyton, 1999).    

Workers’ compensation is compulsory for all employers in most states, depending on the type of organization it is. An exception, Texas changed its law in 2018, allowing employers to opt-out of the mandatory requirement. Employers in that state still have the option of purchasing insurance voluntarily. Other states have considered this type of “opt-out” legislation but have not passed or enacted any others yet (Kersey, 2017).  States with compulsory insurance required of employers have differing regulations regarding which employers must, and which are exempted from, buying into the program.  The US Department of Labor (n.d.b) offers information for state workers’ compensation programs through their website. Another useful website is the State and Local Government on the Net website. This website has links to every state’s workers’ compensation organizations, briefly describing who must provide workers’ compensation in that particular state (State and Local Government on the Net [SLGN], n.d.).

State Workers’ Compensation

The state workers’ compensation insurance is considered a statutory coverage because the benefits are established by state laws, also known as statutory laws. Therefore, the covered benefits and benefit levels differ from state to state. However, all states have some things in common. In general, each provides coverage for medical bills and lost wages for workers who are injured on the job regardless of where the fault for the injury lies, if any. For this to occur, the employees give up their rights to sue an employer if they believe the employer is at fault.  As stated before, this compensation was intended to reduce the legal wrangling that occurred between workers and employers and assure that workers would get timely and adequate medical care without having to fight each step of the way to receive that care (SLGN, n.d.). 

There are instances where employees will hire lawyers and sue to ensure that the benefits provided are correct.  Each state, therefore, has a department or division to handle the workers’ compensation program, with an adjudicator (or judge) who will determine the amount of the benefit to be awarded to the employee from the common fund. When an injury or accident occurs, the employer notifies the state workers’ compensation board or their insurance company, who will do so, depending on the way the statutes are written in that state. The employee, in most states, must file a claim. This differs from state to state, and the employer should provide informat