1. RISK MANAGEMENT FOR ENTERPRISES AND INDIVIDUALS Chapter 16 Risks Related to the Job: Workers’ Compensation and Unemployment Compensation

2. 1 - 2 © 2010 Flat World Knowledge, Inc. 16 - 2 © 2010 Flat World Knowledge, Inc. Learning Objectives  In this chapter, we elaborate on the following:  History of workers’ compensation  Legal enactment of workers’ compensation  Benefits provided under workers’ compensation  Ways that workers’ compensation benefits are distributed  Issues that workers’ compensation insurers must contend with  Features of unemployment compensation

3. 1 - 3 © 2010 Flat World Knowledge, Inc. 16 - 3 © 2010 Flat World Knowledge, Inc. Workers’ Compensation Laws And Benefits  Workers’ compensation: A system to enforce a series of state laws that requires employers to pay workers for their work-related injuries and illnesses with no relationship to who caused the injury or illness.

4. 1 - 4 © 2010 Flat World Knowledge, Inc. 16 - 4 © 2010 Flat World Knowledge, Inc.  History and Purpose  A major barrier to payment was that a worker had to prove an injury was the fault of his or her employer to recover damages.  The injured employee’s ability to recover damages was hindered further by the fact that even a negligent employer could use three common law defenses to disavow liability for workers’ injuries  The fellow-servant rule  The doctrine of assumption of risk  The doctrine of contributory negligence Workers’ Compensation Laws And Benefits

5. 1 - 5 © 2010 Flat World Knowledge, Inc. 16 - 5 © 2010 Flat World Knowledge, Inc.  During the latter part of the nineteenth century, various employer liability laws were adopted to modify existing laws and improve the legal position of injured workers.  U.S. jurisdictions developed the concept of workers’ compensation that compensated workers without the requirement that employers’ negligence must be proved. Workers’ Compensation Laws And Benefits

6. 1 - 6 © 2010 Flat World Knowledge, Inc. 16 - 6 © 2010 Flat World Knowledge, Inc.  Coverage  Is either inclusive or exclusive.  Is compulsory or elective, depending on state law.  Most laws provide coverage only for injuries arising out of and in the course of employment.  All work-related injuries are covered, even if they are due to employee negligence.  Every state provides benefits for occupational disease. Workers’ Compensation Laws And Benefits

7. 1 - 7 © 2010 Flat World Knowledge, Inc. 16 - 7 © 2010 Flat World Knowledge, Inc.  Workers’ compensation laws provide for four types of benefits:  Medical; Survivors’ Benefits; Rehabilitation  Income Replacement (indemnity benefits): The amount and duration of indemnity payments depend on the following factors:  Whether the disability is total or partial, and temporary or permanent  The employee’s compensation  Each state’s maximum duration of benefits  The waiting period  Cost-of-living adjustments Workers’ Compensation Laws And Benefits

8. 1 - 8 © 2010 Flat World Knowledge, Inc. 16 - 8 © 2010 Flat World Knowledge, Inc. Figure 16.3 - Workers’ Compensation Medical Severity*

9. 1 - 9 © 2010 Flat World Knowledge, Inc. 16 - 9 © 2010 Flat World Knowledge, Inc. Table 16.1 - Hypothetical Examples of Texas Workers’ Compensation Income Calculations

10. 1 - 10 © 2010 Flat World Knowledge, Inc. 16 - 10 © 2010 Flat World Knowledge, Inc. How Benefits are Provided  Workers’ Compensation Insurance  Employer’s Risk  Self-Insurance  State Funds  Second-Injury Funds

11. 1 - 11 © 2010 Flat World Knowledge, Inc. 16 - 11 © 2010 Flat World Knowledge, Inc. Workers’ Compensation Insurance  Coverage  The workers’ compensation and employers’ liability policy has three parts.  Workers’ Compensation  Employers’ Liability  Other States Insurance

12. 1 - 12 © 2010 Flat World Knowledge, Inc. 16 - 12 © 2010 Flat World Knowledge, Inc.  Cost  The premium for workers’ compensation insurance typically is based on the payroll paid by the employer.  Factors Affecting Rate  Degree of hazard of the occupational classification  The nature of the law and its administration  Prior losses Workers’ Compensation Insurance

13. 1 - 13 © 2010 Flat World Knowledge, Inc. 16 - 13 © 2010 Flat World Knowledge, Inc.  Loss Prevention and Reduction  The first consideration is to reduce frequency by preventing accidents.  Accident frequency cannot be reduced to zero because not all losses can be prevented.  After an employee has suffered an injury, action may reduce the loss through immediate medical attention, care for the injured employee, and rehabilitation. Workers’ Compensation Insurance

14. 1 - 14 © 2010 Flat World Knowledge, Inc. 16 - 14 © 2010 Flat World Knowledge, Inc.  Residual Market  Various residual market mechanisms, such as assigned risk pools and reinsurance facilities, allow employers that are considered uninsurable access to workers’ compensation insurance.  Eighteen jurisdictions have state-operated workers’ compensation funds in which the state government is responsible for collecting workers’ compensation founds and distributing benefits. Workers’ Compensation Insurance

15. 1 - 15 © 2010 Flat World Knowledge, Inc. 16 - 15 © 2010 Flat World Knowledge, Inc. Employer’s Risk  Industrial accidents create two possible losses for employers:  Employers are responsible to employees covered by the workers’ compensation law for the benefits required by law.  They may become liable for injuries to employees not covered by the law.  Where permitted, self-insurance of this exposure is common.

16. 1 - 16 © 2010 Flat World Knowledge, Inc. 16 - 16 © 2010 Flat World Knowledge, Inc. Self-Insurance  All types of self-insurance require the use of stop- loss coverage through reinsurance.  Most employers who decide to self-insure use third-party administrators to administer the claims or contract with an insurer to provide administrative services only.  Self-insuring reduces benefits only if you or your outside self-insurance administrator will settle claims more efficiently than your insurer.

17. 1 - 17 © 2010 Flat World Knowledge, Inc. 16 - 17 © 2010 Flat World Knowledge, Inc. Insurance or Self-Insurance?  If your firm is large enough to self-insure, your workers’ compensation premium is experience rated.  In choosing between insurance and self-insurance, you should consider the experience rating plans provided by insurers, as well as the advantages and disadvantages of self-insurance.

18. 1 - 18 © 2010 Flat World Knowledge, Inc. 16 - 18 © 2010 Flat World Knowledge, Inc. State Funds  State funds are similar to private insurers except that they are operated by an agency of the state government.  Most are concerned only with benefit payments under the workers’ compensation law and do not assume the employers’ liability risk.  Cost comparisons between commercial insurers and state funds are difficult because the state fund may be subsidized.

19. 1 - 19 © 2010 Flat World Knowledge, Inc. 16 - 19 © 2010 Flat World Knowledge, Inc. Second-Injury Funds  Second-injury fund: Fund that reimburses an insurer (or employer) that pays a workman’s compensation benefit to an employee who suffers more than one job-related injury.  Are financed in a variety of ways.

20. 1 - 20 © 2010 Flat World Knowledge, Inc. 16 - 20 © 2010 Flat World Knowledge, Inc. Workers’ Compensation Issues  As noted by the National Council of Compensation Insurance (NCCI), the following are challenging issues faced by the industry:  Catastrophes such as terrorism  Cost drivers and reform  Capacity  Adequate reserves  Privacy  Erosion of exclusive remedy and scope of coverage  Mental health claims

21. 1 - 21 © 2010 Flat World Knowledge, Inc. 16 - 21 © 2010 Flat World Knowledge, Inc. Workers’ Compensation Issues  Black lung  The Americans with Disabilities Act (ADA)  Ergonomics

22. 1 - 22 © 2010 Flat World Knowledge, Inc. 16 - 22 © 2010 Flat World Knowledge, Inc.  Unemployment compensation programs pay weekly cash benefits to workers who are involuntarily unemployed.  State unemployment compensation programs were established as a result of federal legislation.  The federal tax applies to firms that have one or more employees in each of twenty weeks during a calendar year, or firms that pay $1,500 or more in wages during any calendar quarter. Unemployment Compensation

23. 1 - 23 © 2010 Flat World Knowledge, Inc. 16 - 23 © 2010 Flat World Knowledge, Inc.  The federal law established minimum standards for coverage and benefits.  The amount of the weekly benefit payment a worker may receive through unemployment compensation varies according to the benefit formula in the law of each state. Unemployment Compensation

24. 1 - 24 © 2010 Flat World Knowledge, Inc. 16 - 24 © 2010 Flat World Knowledge, Inc.  To qualify for benefits, unemployed workers must fulfill certain conditions.  Unemployed workers may be disqualified from benefits even if they meet the qualifications described. Unemployment Compensation

25. 1 - 25 © 2010 Flat World Knowledge, Inc. 16 - 25 © 2010 Flat World Knowledge, Inc.  Most unemployment compensation insurance is noncontributory: employers pay all the cost in most states.  The Federal Unemployment Tax Act (FUTA) places a tax on employers at the rate of 6.2 percent of workers’ pay in covered jobs, excluding anything over $7,000 paid to a worker in a year for the purpose of financing unemployment compensation. Unemployment Compensation

26. 1 - 26 © 2010 Flat World Knowledge, Inc. 16 - 26 © 2010 Flat World Knowledge, Inc.  All states have experience rating; that is, they reduce the contribution of employers whose workers have little unemployment.  This system encourages employers to reduce unemployment and stabilize employment to the extent that they can.  The federal portion of the unemployment compensation insurance program is administered by the Employment and Training Administration in the Department of Labor. Unemployment Compensation

27. 1 - 27 © 2010 Flat World Knowledge, Inc. 16 - 27 © 2010 Flat World Knowledge, Inc. Summary  Workers’ compensation was developed as a compromise that would force employers to cover employees’ injuries regardless of cause.  Workers’ compensation laws are inclusive or exclusive, compulsory or elective.  Benefits provided under workers’ compensation are medical, income replacement, survivors’ benefits, and rehabilitation.

28. 1 - 28 © 2010 Flat World Knowledge, Inc. 16 - 28 © 2010 Flat World Knowledge, Inc. Summary  Workers’ compensation benefits can be distributed through private insurance, residual markets, state funds, self-insurance, and second-injury funds.  Workers’ compensation insurers must contend with several issues such as cost drivers and reform, erosion of exclusive remedy, and scope of coverage.  Unemployment compensation programs pay weekly cash benefits to workers who are involuntarily unemployed.