Workers Compensation What is it? How do I work with it? Pesticide Health Effects Medical Education Database(PHEMED) 2010

An Insurance System Most workers in the US benefit from Workers Compensation It covers injuries and illnesses which result from work It is a no fault insurance system –Worker does not need to sue to benefit –Employer cannot dismiss worker claims because worker was at fault –Worker cannot sue employer for damages beyond medical care, disability and lost wages.

When is illness or injury work related? Any injury or illness resulting from or sustained in the course of any occupation or employment. Which means: “More likely than not” due to work or Work must be the “most likely” cause of the condition or “But for the work”, the condition would not exist

Exceptions to “Work Relatedness” From Texas Worker Compensation Website Result from the employee’s horseplay or voluntary intoxication (either alcohol or drug-induced) Arise from voluntary participation in off-duty recreational, social, or sports events Result from “acts of God,” unless a person’s job exposes him or her to a greater than ordinary risk of injury from such acts Are inflicted by someone else for personal reasons unrelated to employment.” Accessed 6/2010 “Benefits are not payable for injuries that are intentional or self-inflicted:

Who is covered and what is covered differs from state to state. For Example: Washington: all employers are required to provide worker compensation - Very strict Wisconsin: Only if employer has three or more full-time or part-time employees - Intermediate Texas: does not require most private employers to carry workers’ compensation insurance - Not strict

Who provides worker compensation? Several state monopoly systems exist - Washington, Connecticut, and a few others Most states have private insurers - e.g. Liberty Mutual, Farm Bureau, Great Northern Most states have a state supported last resort insurer for employers who cannot obtain worker compensation through another carrier.

Common Exceptions: Workers Who Don’t Qualify No coverage in many states Farmworkers Household employees Private contractors Day laborers In home healthcare workers Other than State Systems Federal Employees Mariners Miners Longshoreman

How to File a Claim Generally a form or forms are filled out to initiate coverage States have one or more forms A critical question is always included Your response has implications in terms of decisions to cover or not –Was this caused by work? (or something along those lines)

What You Want Your Note to Say In the case of Injuries Generally, injuries are easy to associate with workplace events Identify the circumstances Confirm it occurred at work Make a simple statement of causation

What Your Note Should Convey The event or exposure occurred at work The frequency of the injurious activity is more common at work (ergonomic injuries) The exposure is logically the cause of the disorder (or has been shown in the literature to be the cause) Mr. Jones suffered exposure at work, the exposure caused the disorder, ergo, the disorder is due to work.

What You Want Your Note to Say Establishing Causation in Work Related Illnesses Is a Bigger Challenge Many systems deal with work related Illnesses less well. You must educate the claims manager with your note. Your time is well spent finding and citing medical literature the shows the disorder has been found to be caused by the exposure your patient suffers. Stating clearly how much exposure the patient had and how this resulted in the illness is important.

What to Say In Your Note For Injuries: “Mr Jones was at his work station doing his usual job when” or “Mr Jones was out on his job doing his usual Blah Blah when” For recurring illnesses: “Mr Jones develops symptoms within Blah Blah minutes of working with Blah Blah (a substance)” “Mr Jones gets better when on vacation or away from exposure” For Chronic Illnesses: Mr Jones has worked for __ years doing Blah Blah. In the course of these years he has routinely been exposed to high concentrations of Blah Blah.

Special Circumstances Workers who are injured while traveling for work are covered for the injury Workers commuting to and from home to work are not covered in the US

Learn More Search the web for Worker Compensation and state name. Most states have a Worker Compensation page that describes requirements, limitations and benefits Worker compensation + WA