CHAPTER © 2012 The McGraw-Hill Companies, Inc. All rights reserved. 13 Workers’ Compensation and Disability

© 2012 The McGraw-Hill Companies, Inc. All rights reserved. Learning Outcomes When you finish this chapter, you will be able to: 13.1 List the four federal workers’ compensation plans Describe the two types of workers’ compensation benefits that are offered by states List the five classifications of work-related injuries List three responsibilities of the physician of record in a workers’ compensation case Explain the difference between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). 13-2

© 2012 The McGraw-Hill Companies, Inc. All rights reserved. Key Terms Admission of Liability disability compensation programs Federal Employees’ Compensation Act (FECA) Federal Insurance Contribution Act (FICA) final report first report of injury independent medical examination (IME) 13-3 Notice of Contest occupational diseases or illnesses Occupational Safety and Health Administration (OSHA) Office of Workers’ Compensation Programs (OWCP) physician of record progress report

© 2012 The McGraw-Hill Companies, Inc. All rights reserved. Key Terms (Continued) Social Security Disability Insurance (SSDI) Supplemental Security Income (SSI) vocational rehabilitation 13-4

© 2012 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 13 Introduction 13-5 Occupational Safety and Health Administration (OSHA)—created by Congress in 1970 to protect workers from health and safety risks on the job –Sets standards to guard against known dangers in the workplace –Businesses must meet these standards or they are subject to significant fines

© 2012 The McGraw-Hill Companies, Inc. All rights reserved Federal Workers’ Compensation Plans 13-6 Office of Workers’ Compensation Programs (OWCP)—administers programs to cover work- related illnesses or injuries suffered by civilian employees of federal agencies Federal Employee Compensation Act (FECA)—provides workers’ compensation insurance for civilian employees of the federal government

© 2012 The McGraw-Hill Companies, Inc. All rights reserved Federal Workers’ Compensation Plans (Continued) 13-7 The four workers’ compensation plans that provide coverage to federal government employees are: 1.The Federal Employees’ Compensation Program 2.The Longshore and Harbor Workers’ Compensation Program 3.The Federal Black Lung Program 4.The Energy Employees Occupational Illness Compensation Program

© 2012 The McGraw-Hill Companies, Inc. All rights reserved State Workers’ Compensation Plans 13-8 States provide two types of workers’ compensation benefits: 1.One pays the worker’s medical expenses that result from work-related illness or injury 2.The other pays for lost wages while the worker is unable to return to work Occupational diseases or illnesses—caused by the work environment over a period longer than one workday or shift

© 2012 The McGraw-Hill Companies, Inc. All rights reserved Workers’ Compensation Terminology 13-9 Work-related injuries are grouped into five categories: 1.Injury without disability 2.Injury with temporary disability 3.Injury with permanent disability 4.Injury requiring vocational rehabilitation 5.Injury resulting in death

© 2012 The McGraw-Hill Companies, Inc. All rights reserved Workers’ Compensation Terminology (Continued) Final report—filed by the physician in a state workers’ compensation case when the patient is discharged Independent medical examination (IME)— examination conducted by a physician to confirm that an individual is permanently disabled Vocational rehabilitation—program to prepare a patient to return to the workforce

© 2012 The McGraw-Hill Companies, Inc. All rights reserved Claim Process Physician of record—provider who first treats a patient and assesses the level of disability –The physician of record in workers’ compensation cases is responsible for: 1.Treating the injured worker 2.Determining the percentage of disability 3.Determining the return-to-work date and filing progress notes Progress report—filed by the physician in state workers’ compensation cases when a patient’s medical condition or disability changes

© 2012 The McGraw-Hill Companies, Inc. All rights reserved Claim Process (Continued) First report of injury—filed in state workers’ compensation cases, containing employer and accident information and patient’s description of the accident Admission of Liability—determination that an employer is responsible for an employee’s claim under workers’ compensation Notice of Contest—determination to deny liability for an employee’s workers’ compensation claim

© 2012 The McGraw-Hill Companies, Inc. All rights reserved Disability Compensation Programs Disability compensation programs—provide partial reimbursement for lost income when a disability prevents an individual from working –Benefits are paid in the form of regular cash payments –The federal government provides disability benefits to individuals through several different programs

© 2012 The McGraw-Hill Companies, Inc. All rights reserved Disability Compensation Programs (Continued) Social Security Disability Insurance (SSDI)— federal disability compensation program for some qualified people –Provides compensation for lost wages to individuals who have contributed to Social Security through FICA payroll taxes Federal Insurance Contribution Act (FICA)– authorizes payroll deductions for the SSDI Supplemental Security Income (SSI)—welfare program that helps pay living expenses for low- income older people and those who are blind or have disabilities