Workers compensation audit in the United States prepared as a cover scheme: injured and ill workers’ medical benefits and wage replacement payments financed through insurance premiums paid by employers to insurers. This structure helps protect employers from financial risks and helps insurers make profits, but it puts employers’ and insurers’ financial motives in direct tension with workers’ fundamental human needs and human rights. Workers experience this conflict in some habits, with vulnerable workers—including low-wage workers, recent immigrants, older workers, temp workers, misclassified “independent contractors,” people with occupational illnesses, and people with disabilities—most affected. Problems include
Groups of workers are disqualified: Farmworkers, domestic workers, employees of small businesses, and people who are self-employed are barred from workers’ comp in a lot of states. Texas and Oklahoma allow any worker to opt-out of the system in total, and a growing number of health conditions related are barred from reporting across many states.
Workers retaliated against Workers who report injuries and file workers’ comp claims regularly face threats and retaliation by their employers, including the loss of their job, loss of hours, and expulsion.
Many injuries aren’t reported: Because employers’ workers’ comp assurance premium is tied to the rate of injuries and illness in a workplace, incentivizing them to keep reported rates down. Employers use intimidation, peer stress, and social stigma to scare workers out of reporting injuries and filing for workers’ comp.
Claims are delayed and denied: Employers and insurers seeking to lower the costs of workers’ comp use every trap in the book to hold up and deny workers’ claims and use their power to shove legislation that tons the deck next to workers. Workers with industrial diseases face particularly high barriers to receiving workers’ comp.
The choice of doctors is limited: Insurance and commerce lobbies have pressure legislature to cut physicians’ payment, and, with few exceptions, states have failed to fund occupational health clinics and streamline paperwork and payments. All these factors drive physicians out of workers’ comp, while insurers and employers push laws that give them ever-greater control over doctors who serve as “gatekeepers” to workers’ comp.
“Benefits” don’t meet needs: The insurance industry and business lobbies have successfully lobbied to reduce the amount of workers’ replacement wages and arbitrarily cut off workers and their families after a period.
Not enough attention on rehabilitation:Workers’ comp roundly fails in what should be one of its leading goals: to prioritize injured workers’ treatment, return to function, and go back to work.
Workers and the community bear the costs: Work injuries and illnesses take both human and economic costs, but insurers and employers only pick up a fraction of the bill, shifting the rest to workers, their families, and the public. Data and evaluation are so lacking that the true costs of this shift are poorly understood.
Workers are treated like adversaries with no participation in governance: Workers are forced to navigate an exceedingly complex and adversarial system. Information is hard to find, hard to understand, and often inaccessible, especially to speakers of foreign languages and people with disabilities. Monitoring and evaluation of workers’ comp outcomes are lacking and excludes workers’ participation.
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