An Ideal Workers Compensation System

An ideal system serves the two primary stakeholders (the employer and the employee).

An ideal system allows and encourages clear, concise, timely and accurate communication (in-person, phone, fax, text, app, semaphore, morse code, smoke signals) between all parties. 

An ideal system provides a prompt provision of fixed and “fair” benefits to the legitimately injured worker within a no-fault system.

An ideal system ensures that all workers are covered by the system. 

An ideal system gives appropriate civil legal immunities to the employer. 

An ideal system utilizes the same criteria for compensability for all participants.

An ideal system encourages and mandates prompt reporting of all claims, a prompt determination of compensability and a prompt provision of appropriate benefits. 

An ideal system encourages and mandates that all claims to be finalized within a reasonable timeline. 

An ideal system provides the “same” benefits regardless of representation. .

The ideal system has few exceptions to the exclusive remedy doctrine. 

An ideal system engages, encourages, and mandates the participation and involvement of the worker in their treatment, benefit provision, recovery and return to work. 

An ideal system incentivizes, mandates, and encourages a high attention to safety in the workplace by both the employer and employee. 

An ideal system is designed so its financial incentives are focused to maximize injury prevention, prompt benefit provision, injury recovery and return to work. (incentives are not always penalties)

An ideal system uses “evidence-based criteria” to determine compensability of the claim as well as the appropriateness of medical care. 

The ideal system provides the appropriate and necessary medical care for the injured worker to achieve maximum medical improvement, and a return to maximum functionality. 

The ideal system provides an appropriate economic safety net for injured employees to meet their primary financial obligations while they are temporarily disabled. 

The ideal system economically reimburses the injured worker for permanent loss of a body part or the loss of its function. (To create consistency of this benefit throughout the United States. ideally every State and the Federal Workers Compensation systems would use the same criteria to make this determination) 

An ideal system facilitates and encourages prompt return to work for the injured workers. (Light duties, modified duties, transitional return to work programs, alternative work duties, and even permanent accommodations of the work sites)

An ideal system determines compensability and provides benefits consistent with the other states and social welfare benefit systems.

An ideal system recognizes, encourages, and builds a systematic coordination of benefits between workers compensation benefits and group health, LTD, STD, and with other employer obligations such as FEHA, ADA, Subsequent Benefits Injury Trust Funds or any other State or Federal benefits or disability programs. Coordination of the benefits should result in an improved economic safety net for the injured worker with minimal cost shifting and minimal overlap between benefit systems. 

The ideal system has specific measurable goals and expectations for all participants. These goals should include compensability decision and benefit provision by the claim’s administrators, timeliness of reporting by the injured workers and employers, quality medical care by the medical community, prompt accurate provision of reports by medical legal physicians, timely decisions by the Judges and prompt case resolution. To do this, the ideal system captures the necessary data and information from the participants, to determine cost trends, as well as the necessary information to measure the goals and expectations. 

An ideal system should result in the employers of the State being economically competitive in the world market. 

An ideal system has appropriate oversight (administrative and Judicial) to ensure that all parts of the system function in accordance with the intent, laws, rules and regulations. Oversight also ensures there is a safety net to continue benefits in case of bankruptcy by the insurance carrier or self-insured employer.  An ideal system does not tolerate any fraud or abuse by any participant in the system.