1. 13 Workers’ Compensation and Disability

2. 13-2 Learning Outcomes When you finish this chapter, you will be able to: 13.1 List the four federal workers’ compensation plans. 13.2 Describe the two types of workers’ compensation benefits that are offered by states. 13.3 List the five classifications of work-related injuries. 13.4 List three responsibilities of the physician of record in a workers’ compensation case. 13.5 Explain the difference between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).

3. 13-3 Key Terms • Admission of Liability • disability compensation programs • Federal Employees’ Compensation Act (FECA) • Federal Insurance Contribution Act (FICA) • final report • first report of injury • independent medical examination (IME) • Notice of Contest • occupational diseases or illnesses • Occupational Safety and Health Administration (OSHA) • Office of Workers’ Compensation Programs (OWCP) • physician of record • progress report

4. 13-4 Key Terms (Continued) • Social Security Disability Insurance (SSDI) • Supplemental Security Income (SSI) • vocational rehabilitation

5. 13-5 Chapter 13 Introduction • Occupational Safety and Health Administration(OSHA)—created by Congress in 1970 to protect workers from health and safety risks on the job • Sets standards to guard against known dangers in the workplace • Businesses must meet these standards or they are subject to significant fines

6. 13-6 13.1 Federal Workers’ CompensationPlans • Office of Workers’ Compensation Programs (OWCP)—administers programs to cover work-related illnesses or injuries suffered by civilian employees of federal agencies • Federal Employee Compensation Act(FECA)—provides workers’ compensation insurance for civilian employees of the federal government

7. 13-7 13.1 Federal Workers’ CompensationPlans (Continued) • The four workers’ compensation plans that provide coverage to federal government employees are: • The Federal Employees’ Compensation Program • The Longshore and Harbor Workers’ Compensation Program • The Federal Black Lung Program • The Energy Employees Occupational Illness Compensation Program

8. 13-8 13.2 State Workers’ Compensation Plans • States provide two types of workers’ compensation benefits: • One pays the worker’s medical expenses that result from work-related illness or injury • The other pays for lost wages while the worker is unable to return to work • Occupational diseases or illnesses—caused by the work environment over a period longer than one workday or shift

9. 13-9 13.3 Workers’ CompensationTerminology • Work-related injuries are grouped into five categories: • Injury without disability • Injury with temporary disability • Injury with permanent disability • Injury requiring vocational rehabilitation • Injury resulting in death

10. 13-10 13.3 Workers’ CompensationTerminology (Continued) • Final report—filed by the physician in a state workers’ compensation case when the patient is discharged • Independent medical examination (IME)—examination conducted by a physician to confirm that an individual is permanently disabled • Vocational rehabilitation—program to prepare a patient to return to the workforce

11. 13-11 13.4 Claim Process • Physician of record—provider who first treats a patient and assesses the level of disability • The physician of record in workers’ compensation cases is responsible for: • Treating the injured worker • Determining the percentage of disability • Determining the return-to-work date and filing progress notes • Progress report—filed by the physician in state workers’ compensation cases when a patient’s medical condition or disability changes

12. 13-12 13.4 Claim Process (Continued) • First report of injury—filed in state workers’ compensation cases, containing employer and accident information and patient’s description of the accident • Admission of Liability—determination that an employer is responsible for an employee’s claim under workers’ compensation • Notice of Contest—determination to deny liability for an employee’s workers’ compensation claim

13. 13-13 13.5 Disability Compensation Programs • Disability compensation programs—provide partial reimbursement for lost income when a disability prevents an individual from working • Benefits are paid in the form of regular cash payments • The federal government provides disability benefits to individuals through several different programs

14. 13-14 13.5 Disability Compensation Programs (Continued) • Social Security Disability Insurance(SSDI)—federal disability compensation program for some qualified people • Provides compensation for lost wages to individuals who have contributed to Social Security through FICA payroll taxes • Federal Insurance Contribution Act(FICA)– authorizes payroll deductions for the SSDI • Supplemental Security Income(SSI)—welfare program that helps pay living expenses for low-income older people and those who are blind or have disabilities