Workers’ Compensation Insurance—Increased Funding for Prevention of Occupational Disease and Injury

[摘要]

Whereas the rates of death, injury and disease from occupational causes remains significant despite recent reductions:

• More than 43 workers are injured every minute of the work week.
• Nearly 15 workers die on the job each day.²
• Workplace injuries cost society an estimated $128 billion in losses in 1996, which equals about one-quarter of each dollar of pre-tax corporate profits.³
• Studies have shown a $4 to $6 return for every dollar invested in safety and health.⁴
• Occupational fatality rates are rising among foreign-born, Spanish-speaking workers and are highest among self-employed workers. Small businesses in general have not been as able to implement preventive services as larger workplaces.⁵

Whereas the American Public Health Association has a history of supporting measures to improve workers’ compensation for occupational injury and disease,^6-9 and prior APHA policy urged that the US workers’ compensation programs actively prevent workplace injury and illness and increase research on work-related illness.

Whereas workers’ compensation insurance was first adopted in Germany in 1884, and adopted by the U.S. federal government for its own workers in 1908, New York State in 1910 and in most other U.S. states between 1910 and 1920 as a means of providing rapid, no-fault compensation to workers injured on the job, at the same time protecting employers from tort liability.

Whereas workers compensation was conceived by labor leaders as a way of prompting employers to make safety reforms in the workplace.¹⁰

Whereas in the United States, workers compensation insurance varies by state, with a few states having exclusive state insurance plans, and other states having a mixture of private and public insurance companies. The individual states created a patchwork of varying insurance systems that does not incorporate sufficient incentives to increase prevention activities in the states.¹¹

Whereas benefit maximum and limited scope of coverage in many jurisdictions restrict many injured workers from getting adequate benefits for work-related injuries and illnesses, and the systems are generally fragmented and incomplete in dealing with health and disability issues that cross lines between occupationally and non-occupationally related injuries and illnesses. A “National Commission on State Workmen’s Compensation Laws” was created as part of the original Occupational Saftey and Health Administration Act. This Commission issued a final report in 1972,¹² and three volumes of supplemental studies regarding workers’ compensation’s failure to cover the entire workforce, provide sufficient cash benefits or timely medical benefits, provide rehabilitation for injured workers, improve safety on the job, and keep administrative and legal costs under control. Little has changed regarding the U.S. Workers Compensation system in the 30 years since that report was issued.

Whereas some recent federal programs have crossed paths with state workers’ compensation programs over coverage and compliance issues (e.g. smallpox vaccination program, Energy Employees Compensation Act Subsection D), and there continues to be little if any coordination between the federal and state programs.

Whereas some states have recognized the importance of prevention of occupational disease and injury through funding of research (Washington State¹³ and Oregon¹⁴), a network of occupational health clinics (New York State¹⁵), and loss prevention services (California¹⁶).

Therefore, be it resolved:

1. A national plan for workers’ compensation should be established, addressing, at a minimum, the recommendations of the National Commission’s report of 1972,12 to insure minimum standards and performance, basic fairness and timely compensation, particularly for occupational diseases. Such a plan should incorporate occupational injury and disease diagnostic and treatment services in any future national health program that is developed.
2. States should enact a surcharge on each state’s workers’ total compensation insurance premiums to be dedicated to a workers’ compensation disability prevention fund, and include adequate funding to insure that each state that elects to have a state OSHA plan could do so without shifting the burden to general taxation.
3. The workers’ compensation disability prevention fund should be guided by a state-wide advisory body involving the participation of representatives of workers and employers, as well as academic researchers and state and local health departments.
4. The workers’ compensation disability prevention fund should be devoted to a combination of high quality and accessible clinic services (similar to New York), outreach and training activities for workers and employers, and research into effective prevention and reduction of disability from occupational disease and injury.
5. Each state should prepare an annual report detailing the rates of occupational disease and injury by type of occupation and industry, age group (minors vs. adults), gender and ethnicity. The report should summarize the results of research supported by the workers’ compensation disability prevention fund, and types of cases evaluated and treated by the occupational health clinics for that state.
6. Each state should adopt relevant occupational health indicators as developed by the Council of State and Territorial Epidemiologists, with specific goals for prevention and progress charted as part of the annual reports detailed above. States should also consider indicators based on sentinel health events (occupational).
7. Each state or regional consortia of states develop an occupational health research agenda, modeled on the National Occupational Research Agenda (NORA) and the Maine Occupational Research Agenda (MORA)18 for their specific industries and leading causes of injury and illness, to be reviewed and modified as often as indicated.

References

1. 5.2 Million injuries/year (2001, US Bureau of Labor Statistics http://stats.bls.gov/iif/home.htm#tables accessed 6/03)/(40 hours/week x 50 weeks/year=2000 hours worked per year). 
2. 5344/365.25=14.63 deaths/day in 2000 (US Bureau of Labor Statistics, http://stats.bls.gov/iif/home.htm#tables accessed 6/03).
3. Leigh JP, Markowitz SB, Fahs MC, Landrigan PJ. Costs of Occupational Injuries and Ilnnesses. Ann Arbor: Univ of Michigan Press, 2000. Leigh JP, Markowitz SB, Fahs MC, Shin C, Landrigan PJ. Occupational injury and illness: Estimates of costs, mortality and morbidity. Arch Intern Med 1997;157:1557-68. Leigh JP, Cone JE, Harrison R. Costs of Occupational Injuries and Illnesses in California. Prev Med 2001;32:393-406. According to the U.S. Commerce Department, Survey of Current Business, December 1996:p8, seasonally-adjusted annual pre-tax corporate profits were $654.7 Billion. See also Smith L. Do You Know How Much Accidents Are Really Cutting Your Business? Colorado State University Health & Safety Consultation Program, 1996, cited in Council on Practices and Standards (CoPS) of the American Society of Safety Engineers (ASSE), White Paper Addressing the Return on Investment for Safety, Health and Environmental (SH&E) Management Programs, approved June 8, 2002. Web citation: http://www. cdc.gov/niosh/elcosh/docs/d0100/d000047/d000047.html last accessed 6/03.
4. On August 29, 2001, Liberty Mutual Insurance Company released a report titled: "A Majority of U.S. Businesses Report Workplace Safety Delivers a Return on Investment." The Liberty Mutual survey shows 61 percent of executives say $3 or more is saved for each $1 invested in workplace safety. OSHA’s Office of Regulatory Analysis has stated: "our evidence suggests that companies that implement effective safety and health cans expect reductions of 20% or greater in their injury and illness rates and a return of $4 to $6 for every $1 invested."
5. Census of Fatal Occupational Injuries, 2001. Table A-7 Fatal Occupational Injuries by Worker Characteristics and Event or Exposures, All United States, 2001. http://www.bls.gov/iif/oshwc/cfoi/cftb0151.pdf accessed 6/03.
6. American Public Health Association Policy Statement 7224: Workmen’s Compensation Reform. APHA Policy Statements, 1948-present, cumulative. Washington, D.C., http://www.apha.org/legislative/policy/1948-2002policies.htm accessed 6/03.
7. American Public Health Association Policy Statement 8213: Asbestos Disease Compensation. APHA Policy Statements, 1948-present, cumulative. Washington, D.C., http://www.apha.org/legislative/policy/1948-2002policies.htm accessed 6/03.
8. American Public Health Association Policy Statement 8329 (PP): Compensation for and Prevention of Occupational Disease. APHA Policy Statements, 1948-present, cumulative. Washington, D.C., http://www.apha.org/
9. legislative/policy/1948-2002policies.htm accessed 6/03.
10. American Public Health Association Policy Statement 9509: Workers’ Compensation Reform. APHA Policy Statements, 1948-present, cumulative. Washington, D.C., http://www.apha.org/legislative/policy/1948-2002policies.htm accessed 6/03.
11. Minutes of evidence accompanying the first report to the Legislature of the State of New York by the Commission appointed under Chapter 518 of the Laws of 1909 to inquire into the question of employers liability and other matters 92-94 (1910), cited in John Fabian Witt, The transformation of work and the law of workplace accidents, 1842-1910. Yale Law Journal; New Haven 1998;107:1467-1502. See also Christopher Howard, Workers’ Compensation, Federalism and the Heavy Hand of History. Prepared for delivery at the Wiener Inequality & Social Policy Seminar Series, John F. Kennedy School Of Government, Harvard University, March 19, 2001. http://www.ksg.harvard.edu/inequality/Seminar/Papers/Howard.PDF.
12. Spieler EA. Perpetuating Risk: Workers’ Compensation and the Persistence of Occupational Injuries. Houston Law Review 31, No. 1.
13. National Commission on State Workmen’s Compensation Laws. 1972. The Report of the National Commission on State Workmen’s Compensation Laws. Washington, D.C.: National Commission on State Workmen’s Compensation Laws.
14. Safety & Health Assessment & Research for Prevention (SHARP) Program http://www.lni.wa.gov/sharp/sharpinfo.htm accessed 6/03.
15. The Occupational Safety and Health State Plan Association, Grassroots Worker Protection: How State Programs Help to Ensure Safe and Healthful Workplaces, 1999. http://216.239.51.100/search?q=cache:xiit_u3dYKoJ:www.osha.gov/fso/osp/oshspa/grassroots_worker_protection99/+Grassroots+Worker+Protection&hl= en&ie=UTF-8 accessed 6/03.
16. Tuminaro D. Organizing for a Statewide Network of Occupational Disease Diagnostic Clinics. New Solutions 1990;1:18 pages. Also see: http://www.health.state.ny.us/nysdoh/environ/occupate.htm accessed 6/03.
17. Chapter 3.2. California Occupational Safety and Health Regulations (CAL/OSHA) Subchapter 1. Regulations of the Director of Industrial Relations Article 6. Workers’ Compensation Loss Control Consultation Services, Annual Health and Safety Loss Control Plan—Requirements and Procedures §339.4. Provision of Loss Control Consultation Services. http://www.dir.ca.gov/title8/339_4.html accessed 6/03.
18. http://www.state.me.us/labor/bls/MORA4-10-02minutes.htm accessed 6/03.

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[发布日期] 2003-11-18

[学科分类] 医学（综合）