Workers comp programs are facing new challenges


This guide outlines the rising problems being faced with workers comp programs, why it is happening, and how to face them.

When it comes to workplace injuries, everybody wants protection. Workers don’t want to get injured on the job, but expect workers’ compensation if they do. Employers don’t want to lose productivity due to injury, but also want to avoid workplace injury litigation. This raises problems for workers comp — or workplace compensation — programs.

Insurers don’t want to pay for fraudulent injury claims, so they impose tight claim deadlines and require a significant amount of proof that the injury is a) legitimate, b) work related, and c) not the result of a worker’s own irresponsibility (like when an employee is intoxicated).

Even individual states have different laws concerning workers comp. Some states only require larger businesses to carry workers’ compensation insurance. Illinois requires all businesses (apart form sole proprieterships) to have insurance. Texas is the only state that doesn’t require any business to have insurance unless they contract with a government entity.

On top of all this, there are always new societal challenges to the efficacy and sustainability of the workers’ compensation program as a whole. Better understanding ensures better protection for ourselves after a workplace injury.

Problems for workers comp

Here we will look at some of the new challenges facing our workers’ compensation program.

Better Medical Technology Drives Cost

Nothing can drive up costs quite like success. Modern medicine, facilities and resources have helped workers survive and recover from serious injuries at a much higher rate. Traditionally, workers comp has never been overly affected by medical inflation. However, our ability to treat injured workers at the most catastrophic level is raising medical costs significantly.

Accident survivability and longer life expectancy after a serious injury is greater and longer than ever thanks to better on-the-scene care, evacuation methods and trauma centers. And when everything works together to save and provide a better quality of life to a worker post-injury, that is an invaluable service. Unfortunately, too many of these accidents are the result of some form of irresponsibility, and the overall healthcare system is unduly stressed.

Rise in Workplace Violence

It is estimated that workplace violence is causing businesses to lose $250 to $330 billion every year. Furthermore, incidents of workplace violence are on the rise. An employee is entitled to workers comp if the injury caused by violence is work-related: if a doctor is assaulted by a patient during a checkup; if a clerk is assaulted by a customer; or if any worker is the victim of an active shooter on the premises.

That being said, with the rise of violence in the workplace, insurers will require clear proof that the incident was indeed work-related and not a personal matter. An injury sustained by a fight based on a personal matter is not covered by workers’ compensation.

Employee Vs. Independent Contractor Eligibility Disputes

The modern work ethos is more fluid than ever. The “gig economy” provides greater freedom and autonomy for workers, but often at the cost of security and protection. Currently, state and federal lawmakers are debating what work-related injury protections should be provided to outsourced workers. Adding to the confusion is that certain tax laws might include independent contractors as ‘employees’, but not workers comp rights.

The U.S. Department of Labor is trying to umbrella more independent contractors with full employee protection that includes workers’ compensation rights, but situational cases will ultimately come down to a court’s interpretation. Legitimizing an independent contractor’s claim to full compensation has become the test for a workers’ compensation lawyer navigating new laws at the state and federal level.

Transparency and Workplace Safety

Transparency is one of the most commonly used words in business today. It means a clear window into how businesses conduct themselves and it includes how dedicated they are to employee safety. In the past, it was easier for companies to cut safety corners and sweep seemingly minor incidents under the rug. Fortunately for today’s workers, the level of sophistication in documenting and reporting safety violations is high, and at everyone’s fingertips.

Digital communication is instant…and forever. It is simply not in a company’s interest to pay insufficient attention to their facilities, their equipment, their vehicles, or their employees’ training.

Employees have the tools to provide clear work-related injury documentation. It is in their interest to provide a workers’ compensation lawyer with proof as soon as possible before the facts of the matter slip out of focus and insurers develop reasonable doubt.

Conversely, in fairness to employers, insurers and the health care system as a whole, it is an employee’s responsibility to be forthright about fraudulent claims they may have witnessed; work-related injuries that are a direct result of employee negligance; or violent occurances that are the result of a personal matter and not a professional one.


In short, protecting ourselves at the workplace means protecting everybody’s right to prosper within the rule of law.


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