Clinics in occupational and environmental medicine
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Clin Occup Environ Med · May 2004
ReviewWorkers' compensation: a historical review and description of a legal and social insurance system.
The workers' compensation system is a no-fault legal and social insurance system established to address compensation issues that involve work-related injuries and illnesses. The system was developed in response to dissatisfaction with common law litigation on the parts of injured workers and employers. The history of the development of workers' compensation is reviewed, and a general description of the system is offered, including discussion of state law and insurance structures, benefits and costs, administrative boards/commissions, and the federal systems for workers' compensation and related programs. The recent history of the workers' compensation system is provided, the recommendations of the National Commission on State Workmen's Compensation Laws in 1972 are reviewed, and the problems and state-initiated changes in worker's compensation that occurred during the 1990s are discussed.
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Clin Occup Environ Med · May 2004
ReviewManaging workers' compensation costs: success of initiatives to change outcomes.
The cost of workers' compensation health care has been a challenge during the past few decades. Various programs have been initiated on the local, state, and national levels to address this issue. The purpose of this article is to examine some of the programs that have initiated cost control measures. ⋯ The initiatives reviewed herein were instituted at medical centers in Maryland and Pennsylvania, at casino hotels in Nevada, at an occupational health clinic in Ohio, at an electrical union in New York State, and at an insurance company. Initiatives in Minnesota and Washington State are also described. Sharing the outcomes of initiatives may allow such research to be translated into action on a broader scale.
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Some individuals in the health care system base their actions primarily on individual economic incentives rather than ethical and societal standards. These actions are considered fraudulent when they can be proven to have violated specific laws or statutes and can impact workers' compensation costs. ⋯ Ethical and efficient practice style, in conjunction with the maintenance of clarity and objectivity in the evaluation of patient symptoms, can help to reduce the degree to which provider and patient fraud is allowed to develop and flourish. In understanding the factors that promote fraudulent behavior and being able to recognize and manage such behavior, health care providers may impact the perpetuation of fraud and its impact on the workers' compensation system.