How Can Workers' Compensation Systems Promote Occupational Safety and Health?

Stakeholder Views on Policy and Research Priorities

by Michael Dworsky, Nicholas Broten

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Research Questions

  1. What are the beliefs of key workers' compensation stakeholder groups about system challenges and research priorities?
  2. Which policy options and research efforts are most important for reforming workers' compensation policy to promote OSH and the well-being of workers?
  3. What are the conflicts or tensions among advocated policy goals, including areas where specific system features, policy choices, or practices have unintended consequences for workers?

Stakeholders involved in workers' compensation systems have long voiced concerns about the extent to which workers' compensation serves to promote occupational safety and health (OSH) and the well-being of injured workers. However, it is not clear how much consensus there is about the specific challenges to OSH and worker well-being in the workers' compensation system or how to address those challenges.

The National Institute for Occupational Safety and Health (NIOSH) requested that RAND explore the beliefs and priorities of key workers' compensation stakeholder groups about system challenges and research priorities that, if addressed, would be most useful for reforming workers' compensation systems to promote OSH and the well-being of workers. To address these questions, RAND conducted a literature scan to identify published criticisms of current workers' compensation systems, focusing on the implications of workers' compensation for workers' safety, health, and economic well-being. After producing a compendium of such critical perspectives, RAND then convened a series of conversations with selected representatives from five key stakeholder groups: workers, employers, claims administrators, state agency leaders, and occupational health care providers.

The findings of this study can be organized into three groupings. First, major themes were distilled from published critiques of workers' compensation policy. Second, stakeholder perspectives on the most important system challenges were gathered. Third, policy solutions and research needs suggested by stakeholders were identified. In general, stakeholders agreed with the published critiques but placed a greater emphasis on concerns about health care delivery, return to work, and injury prevention.

Key Findings

Published critiques identified numerous problems with current workers' compensation policy.

  • Coverage remains less than universal, and benefit adequacy is insufficient.
  • Problems remain in disability determination and medical treatment.
  • Challenges remain in vocational rehabilitation and return to work.
  • Safety promotion practices have been somewhat successful but create complex claiming incentives.
  • System complexity is a drag on performance.

Stakeholders identified many shortcomings of workers' compensation policy as important challenges to worker outcomes.

  • New approaches to injury prevention and disability management are needed.
  • Declining coverage of workers and health conditions prevents workers' compensation from serving its purposes.
  • Inefficient claim management and dispute resolution processes harm workers and drive up costs.
  • Health care for injured workers is often fragmented and of low quality and is not designed to reward worker outcomes.

Policy priorities and research needs suggest a two-pronged research agenda for improving workers' compensation policy.

  • Stakeholders attached a high priority to development of new models and interventions for health care delivery, injury prevention, dispute resolution, and disability prevention.
  • Scientific evidence on causation is badly needed to guide workers' compensation systems in handling occupational disease and preexisting conditions.

Recommendations

  • State policy experimentation in workers' compensation should be encouraged in part by federal investments and support for rigorous, independent evaluations. NIOSH and other research agencies should produce a wide range of more basic scientific, economic, and other social-scientific evidence on questions pertaining to epidemiology, system performance, and financing.
  • Many important questions, particularly those related to causation, apportionment, and occupational disease presumptions, will generally require observational study and epidemiological methods. Research efforts should be guided by explicit theories of employment outcomes, disability progression, employer decisionmaking, and other relevant behaviors.
  • Policy development should be informed by conceptual frameworks that enable quantitative tradeoffs between competing social objectives. Certain policy challenges that might be amenable to fundamental reforms or entirely new insurance arrangements should be an occasion for policy analysts to develop more detailed policy proposals.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Objectives and Recent Critiques of Workers' Compensation Policy

  • Chapter Three

    Stakeholder Views of System Challenges

  • Chapter Four

    Policy Options and Research Needs

  • Chapter Five

    Suggestions for a Research Agenda to Improve Workers' Compensation Policy

  • Appendix A

    Discussion Participants

  • Appendix B

    Overview of Workers' Compensation Systems

  • Appendix C

    Compendium of Critical Perspectives on Current Workers' Compensation Policy

The research described in this report was prepared for the National Institute for Occupational Safety and Health (NIOSH) and conducted by the Justice Policy Program within RAND Justice, Infrastructure, and Environment.

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