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Injuries at Work

Occupational injuries and illnesses are among the five leading causes of morbidity and mortality in the United States. Each year more than 5000 workers are killed on the job in the United States. More often these are in transportation, but also #agriculture, forestry, and construction, or roofers. Violence is the second most common fatal event at work. Each day, 150 workers die from hazardous working conditions. Asthma is now the most common occupational respiratory disease. About 15 percent of new-onset #asthma cases in adults are work-related.

Workers' compensation insurance often fails to compensate most occupational injuries and illnesses, including fatalities. Only a small fraction of occupational disease are covered by workers' compensation and only a small fraction of those suffering evry receive workers' compensation benefits. A more recent study found that insurance through workers' compensation absorbs only about 21 percent of the true costs of occupational injuries and illnesses.

Tens of thousands of chemicals are in common commercial use in the United States, thousands of them more than even a million pounds per year, yet only 7 percent of those have been screened for toxicity and less than half of those have been studied thoroughly. Occupational health workers are those who help identify causation in the workplace, yet many companies don't employ these professionals so then investigations occur as part of litigation procedures. Although more than half a million chemicals are found in work settings, any many millions of workers are exposed to these substances, only 10,000 workers' compensation claims for illnesses are filed each year.

Workplace exposure to carcinogens accounts for about 5 to 10 percent of all cancer cases, yet fewer than one percent of cancer patients ever receive any settlement from employers. NIOSH estimates that 16 to 17 percent of lung cancer cases in men and two percent of the cases in women are work-related. All of these being totally preventable, yet workers continue to be exposed, primarily because so few are repeated. With the exception of #cancers caused by exposure to asbestos, few occupational cancer cases ever receive workers' compensation benefits.

What is Your Occupation?

This is one of the more important questions a primary care provider can ask their client, not simply because it is helpful to understand the client as a person, and appreciate their social roles, but also because this can help us discern dis-ease as it related to their working environment. Working Americans spend greater than half of their waking hours at work, and the impact of environmental exposures and stress factors encountered on the job can have significant effect on the worker's health, both physical and mental. It can also profoundly influence the health of their families and communities and contribute to the social and economic costs to society as a whole.

Asthma may be related to seasonal exposures, but it may also be related to exposure to isocyanates on the job. Without a thorough history, the correct diagnosis, treatment plan, and prevention may not be achieved, and especially compensation for the worker for any consequence to their exposure. A history of headache while at work suggests potential solvent or carbon monoxide exposure, and cough and wheezing while at work or predictably delayed after leaving work may suggest irritant or triggering allergen exposure. A history of fevers and back pain in a clinical laboratory worker or slaughterhouse worker suggests possible brucellosis.

What kind of work do you do? Do you think your health problems are related to your work? Are your symptoms better or worse when you're at home or at work? Are you now or have you previously been exposed to dusts, fumes, chemicals, plastics, radiation, or loud noise? Are you provided protective equipment?

The Agency for Toxic Substances and Disease Registry (ATSDR), a federal public health agency of the U.S. Department of Health and Human Services, provides health information to prevent harmful exposures and diseases related to toxic substances.

Workers' Compensation

Clinicians who care for those injured at work have the responsibility of determining whether a worker's injury or disease claim was specifically caused by work activity - a process that often engenders an adversarial relationship between the patient, the clinician, and the employer. This care must be efficient as well, because not only do we want to minimize suffering, but we want to ensure the flow of benefits in a timely manner, and help them return to a safe working environment.

Most all of Europe had workers' compensation laws in the late 1800s, but the movement didn't begin in the United States until about 1908. The Federal Compensation program provides federal employees who are injured in the performance of a duty with worker's compensation benefits. These include wage-loss benefits for total or partial disability, monetary benefits for permanent loss of use of the body part, medical benefits, and vocational rehabilitation. Survivor benefits are also available for dependents of workers who died as a result of a workplace injury or occupational disease. This program is part of the U.S. Department of Labor and supports employees of the Postal Service, the Department of Homeland Security, and the Department of Veterans Affairs, including military which is by far the largest federal program in workers' compensation.

Each of the 50 states, the District of Columbia, and the US territories also have their own workers' compensation programs and of course, they all differ in who and what is covered. When laws are adopted in each state, they typically follow the British model more closely than our governmental program. In 46 states, all or most all insurance coverage is provided by private companies. Some states give employers control over their choice of clinician and some states give the choice of provider to the employee.

The compensation system works on a no-fault principle in that no matter whose fault it is, the employer is responsible for providing medical treatment and compensation benefits to the injured employee. There is also a basic tenet that workers should receive quick payment for work injuries, and in return, the employer receives immunity from being sued. When injured at work, and payment is provided, the injured worker can not then sue regardless of the extent or circumstances of either the worker's or employer's culpability or negligence that led to the injury or illness.

To receive compensation, the injury or illness must arise out of and in the course of employment, and this is the responsibility of the clinician to identify and articulate in the medical record. A work injury or illness that is determined to activate or accelerate a preexisting condition also is compensable in many states, although varies state to state. When injuries are self-inflicted, related to drugs and alcohol, #violence at work, or are #suicide related, this is again dependent upon individual state laws.

In the United States, the social security system is the main funding source for workplace disabilities outside of the workers' compensation insurance system. To qualify the worker must be unable to work in substantial gainful employment and then their benefits are calculated essentially the same as those upon retirement. The #disability must be expected to last more than a year or result in premature death.

May You be Impacted?

Occupational diseases affect 15 to 20 percent of all workers. Conservative estimates are that five to ten percent of cancers, myocardial infarctions, strokes, and transient ischemia are caused by workplace factors. The vast majority of individuals with known or suspected occupational disease do not file claims for workers' compensation benefits. When there is some period of latency, benefits are seldom received.

Many states have rewritten their workers' compensation laws, making it even more difficult for injured workers to receive compensation for occupational disease, and there is significant challenge when one has to prove that there was a culmination of trauma that led to back pain for example, or emotional trauma. There are multiple causes for most all diseases, so assigning responsibility to the employer can be a real challenge and typically these incidences must be reported, in writing, within a week.

Past claims for workers' compensation is often used as an unspoken reason for denying job applicants. An employer may access digital information on workers' compensation claims history, use the data to company advantage, and leave no paper trail. The job applicant never knows a thing about it.

Workers' compensation insurance coverage is compulsory for most private employment, and cover 87 percent of all wage and salary workers, but domestic workers, those who are self-employed, agricultural workers, and casual laborers go without liability coverage.

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