Workers’ compensation is a state program whose rules vary substantially by
state. The basic structure of these programs guarantees compensation for
work- related injuries and illness without the need to prove fault on the
employer’s part. The amount of compensation is fixed for each injury, and the
employee has a very limited right to sue the employer for additional
compensation. Because this compensation is much lower than the employee
might recover in the courts, workers’ compensation laws are often criticized for
not creating a sufficient incentive to protect workers. The courts have allowed
this limitation of liability because all injured workers receive medical care and
some compensation. In contrast, private civil litigation is generally not
available.
All physicians who treat work- related injuries and illnesses should understand
their state workers’ compensation system. Failing to comply with reporting
requirements and claims filing procedures can deny the patient needed care
and delay payment of physician charges. Physicians should be prepared to
provide reports to workers’ compensation hearing examiners. They should also
realize that workers’ compensation laws have not eliminated litigation over
workplace injuries. Employees must still litigate whether their injury was
workplace related and the extent of their incapacitation. Physicians should
contact the agency that regulates workers’ compensation in their state for
specific information about complying with its claims procedures.