Workers' compensation regulations from ancient Sumeria to modern times

Financial and Economic Impact of Worker's Compensation Regulations And Compliance

The program and concept of Workers' Compensation might appear to be a product of a civilized society and the modern era, but nothing could be further from the truth. In fact, Workers' Compensation has essentially been around for as long as people have been completing task for payment of some form of another, because people have always been getting hurt in some way, on the job. "The history of compensation for bodily injury begins shortly after the advent of written history itself1. The Nippur Tablet No. 3191 from ancient Sumeria in the Fertile Crescent outlines the law of Ur-Nammu, king of the city-state of Ur. It dates to approximately 2050 B.C.2. The law of Ur provided monetary compensation for specific injury to workers' body parts, including fractures. The code of Hammurabi from 1750 B.C. provided a similar set of rewards for specific injuries and their implied permanent impairments. Ancient Greek, Roman, Arab, and Chinese law provided sets of compensation schedules, with precise payments for the loss of a body part. For example, under ancient Arab law, loss of a joint of the thumb was worth one-half the value of a finger. The loss of a penis was compensated by the amount of length lost, and the value an ear was based on its surface area. All the early compensation schemes consisted of "schedules" such as this; specific injuries determined specific rewards" (Guyton, 1999). This compensation schema demonstrates the notion that is present today that not all injuries are as serious as others and that different injuries deserve different forms of payment.

Of course, one could make a strong case for the fact that this system was coarser than the one in place today (though some disgruntled workers might argue the opposite) as the value of a body part seems largely connected to its size. Today the concepts of "quality of life" and "pain and suffering" have been introduced and compensation can be immediately linked to these two issues. For example, the notion of a man being compensated for the loss of part of his penis based on the length of this organ that is lost is a completely ludicrous notion to a modern audience. The contemporary mentality is that once a man's penis is damaged or deformed in any sort of way, the appropriate compensation thus begins.

However, despite the fact that the notion of compensation for bodily injuries is as old as work itself, it didn't really leave an imprint upon modern society until the industrial revolution. Even though the industrial revolution was a crucial and exciting time for America and one which created an enormous push for modernity and progress, there was a price to pay for the rapidity of expansion. It was indeed the machine age, and human beings were the ones creating and operating these machines. At the same time, there was a certain give and take push and pull and margin of error and mistakes that had to occur. "As economic and industrial activities flourished, the number of work injuries also grew. The increasing use of machinery, new concepts of producing goods, and the pressure of increased demand for products resulted in more injury problems without solutions for employers and employees. For the most part, workers who were injured on the job had no recourse other than to sue their employers at common law, an expensive and time-consuming process. The court system was crowded, causing long delays. Compensation for injuries was usually insufficient and uncertain. The employee sometimes was forced to bear the expense of injury himself or had to throw himself on the mercy of welfare" (aascif.org). This demonstrates the very real consequences of not having a proper system in place for workers to seek financial help within, for their injuries. Without a formal system of workers' compensation the very real consequences were things like clogged court systems, overuse of the welfare system, and generally large amounts of wounded employees who had nowhere else to turn and no way to support their families. This demonstrates how even though this emerging machine age was providing a definitive benefit to society; it was also damaging a large chunk of the workers contributing to a participating in this crucial time.

Eventually, "Laws were enacted to provide workers injured on the job with prompt, equitable, and guaranteed benefits. Injured workers received medical care and disability income irrespective of fault. Employers, in turn, were protected from potentially catastrophic loss by a stated amount of specific benefits for the injuries suffered by the employee. The worker was prohibited from filing suit while the employer was obligated to pay the mandated benefits" (asscif.org). This clearly demonstrates how such a program protected both the company and the worker. The company benefited from knowing that they wouldn't be sued and forseeably put out of business indefinitely, and the employee benefited from knowing that he would be taken care of, if anything should happen to him on the job. Aside from signaling a higher level of humanity for workers and employers, giving both of them peace of mind, the modern emergence of workers' compensation meant that work was regulated in such a way that it wouldn't wreak havoc on the court system or on the welfare system.

Analysis of the Field

Workers' compensation is a vital component related to employment and safety, but at the same time, it's a program that doesn't simply exist because people want it to: it needs to have a strong financial backing and needs to be fiscally supported. Finding ways to make workers' compensation more affordable for employers is pivotal as the overall success and longevity of the program depends on it. One of the major issues present in worker's compensation today is as a result of increasing prescription drug costs. "Alex Swedlow, Vice-President of Research for the California Workers' Compensation Research Institute, reported on CWCI project which reviewed workers' compensation pharmaceutical costs. Through analysis of detailed claim specific medical data, CWCI uncovered some very specific causes for the growth in pharmaceutical costs. One interesting result was the rise in physicians dispensing drugs within their own clinics; this practice allows physicians to circumvent pharmacy fee schedule restrictions through clever repackaging techniques" (iaiabc.org, 2010). This highlights an issue that's neither the fault of the employee or the employer; rather it demonstrates a fault of one of the parties: involved doctors.

Doctors, it appears, are taking the opportunity to raise prices, simply by virtue of the fact that they can. While this increases profits for them, it means that certain workers' comp benefits are becoming pricier, and with that, less affordable. However, part of the increased prescription costs is just by virtue of the fact that the drugs prescribed are pricier by nature. "Although a physician-dispensing is certainly contributing to the rise of drug costs, the most significant increase can be attributed to the shocking growth in opioid prescription use. The use of Schedule II drugs, which have restrictive applications for the relief of serious chronic pain, is being prescribed for a variety of claims that historically did not require such drugs. Swedlow's research showed prescription patterns in California in which a tiny fraction of physicians were generating a very large share of the opioid prescriptions" (iaiabc.org, 2010). Opioids are extremely powerful drugs which are expensive by nature. However, this isn't the only reason that their usage is driving up the system costs all over the nation: opioids have an extreme and indelible impact on the lives of workers. "Workers on opioids are often highly dependent, face delays in return to work, and may suffer other physical or psychological challenges due to addiction" (iaibc.org, 2010).

This issue with workers' compensation and the rate of prescription of opioids is completely out of control. It has been calculated that between 55-86% of all Workers comp claimants are on opioids of some sort as a means of soothing chronic pain (Morgan, 2012). However, the problem with this fact is that it's generally an effective long-term drug when it comes to conditions like cancer treatments (Morgan, 2012). In fact, there's hard evidence which points to the prevalence of opioids doing more harm than good; the Center for Disease Control cites how deaths related to the usage of painkillers has increased at least 300% in the last 13 years, more than the deaths connected to cocaine or heroin usage combined (Morgan, 2012). In fact, the incorrect usage or abuse-related addiction to painkillers was accountable for half a million trips to the ER in 2009, a number which had doubled in just half a decade (Morgan, 2012). If these numbers demonstrate anything, they showcase the vital need of a better means of regulation for opioid use and workers. It's a heavy-handed approach which demonstrates poor health care techniques and shoddy judgment on behalf of medical professionals. It's so problematic as opioids are far too potent, powerful and addictive forms of substance to give individuals dealing with chronic pain. It's the equivalent of giving a child a semi-automatic weapon to protect himself with, when a guard dog would be more appropriate. "The recent shift in prescribing patterns to more patients consuming opioid medications is more prevalent today than ever before. Opioid medications are now being prescribed at higher dosages in pure form and are routinely making their way into the hands of injured workers without the proper controls, regardless of health risks.

Escalating problems such as overdose, addiction, and even death have reached epidemic proportions, according to the Centers for Disease Control (CDC), and are now commonly reported in association with workers' compensation claims… 'To our knowledge, this is the first scientifically validated study to demonstrate that long-acting opioids, even if taken just once, leads to catastrophic claim cost,' Tower said" (prnewswire.com, 2012). The problem lies fundamentally with the way that the medical community is communicated with. There needs to be strict and lucid dialogue between workers compensation leaders and leaders of the medical community in order to adequately convey the devastating impacts that the overzealous usage of opioids is having on workers. However, if professional greed gets in the way of doctors behaving in a manner which benefits their patients, then it's likely that there will need to be state or national government regulation of this trend. It's the lack of regulation, monitoring and control which is making this issue as a detrimental and catastrophic as it is, when in reality, it doesn't have to be this way. The best way to ensure that workers don't become addicted to prescription painkillers is to not give them highly addictive prescription painkillers. It's comparable to how the exposure to violence can incite children to act violently. To prevent this violent behavior one needs to prevent contact with the source which incites the violence. In many respects prevention truly is exceedingly simple, though in this case it absolutely does revolve around adequate regulations: "Ultimately, our research indicates the need to monitor or intervene on claims treated with long-acting opioids for nonmalignant chronic pain," Patrick Walsh, vice president and chief claims officer for Accident Fund Holdings, said. "Our goal is to protect our injured workers from addiction or not being able to return to work" (prnewswire.com, 2012). One of the revelatory aspects of this quote is that it demonstrates the rather short-sighted aspect of the program as a whole. Too many of aspects of the program focus on just treating the injury rather than preventing addiction or thinking about the overall health and wellness of the injured worker as a whole.

Another issue that needs to be closely examined in the arena of workers compensation is the emergence of new occupation diseases. For example, just as the industrial age created new injuries and diseases for workers, the new technology of today is doing the same thing. One simply cannot embrace the advent and emergence of new technologies without acknowledging how those new technologies are going to impact the health of those who work with them day in and day out. The new occupational diseases that are on the scene are "…including black lung, siliceous, and hearing loss. One area to track closely is the potential health impacts of nanotechnology to injured workers. The use of nanoparticles in the industrial process is growing, resulting in more and more workers exposed to these materials. The very small nature and unusual characteristics of nanotechnology could lead to an outbreak of occupational disease claims in the next 10 or more years. While there is very little medical evidence exposure limits or the risk of injury to humans, it is an area of particular risk that should be monitored" (iaiabc.org, 2012). The most pertinent issue with occupation diseases is that they can largely be prevented, if adequate measures are taken. Occupational disease represent a failure of employers to take the proper measures to protect their employees, often placing them in unsafe work environments and causing them to bear the biological burden of these hazardous or toxic environments.

Black lung (aka, miner's asthma, silicosis, coal worker's pneumoconiosis) is a common example of this destructive phenomenon (umwa.org). Upon current calculations, it is believed that around 1500 former coal miners die annually a painful death in out of the way rural communities, away from the press and all forms of publicity -- thus, this is a disease which is largely unknown about, another tragedy which aggravates the disease and essentially allows it to flourish (umwa.org).

Back in 2011, there was some federal intrusion on to this issue in order to improve circumstances for employees. For example, The National Institute for Occupational Safety and Health gave miners free screenings to be tested for black lung disease via the month of March. This was done so that screening could assist in intervening before the disease became fatal or life threatening but also as a means for providing workers with proper and official documentation that they had in fact contracted an occupational disease (Eley, 2011). Screening is absolutely crucial as for a gradual condition like black lung; the disease sets in slowly as a result of all the years of breathing in dust filled air from mines successively inhaled for a period of years.

These pertinent issues demonstrate how the field of workers compensation is still under-going progress and needed development. For example, while there are agencies in place for workers to go to for their needs, there's still a ways to go in the field. Largely based on the issues discussed here, it appears that there is a tremendous amount of compensation that employers could engage in to better protect their workers but do not. It's likely that for the rest of the 21st century, a greater focus will be on the power of prevention.

Future Directions

As alluded to earlier, one of the most definitive ways to reduce the usage of opioids and to minimize the numbers of employees that become addicted to such powerful, debilitating substances is to reduce the number of opioid prescriptions that are written. The bulk of the solution is actually that simple: workers can't become addicted to a substance that they've never been introduced to. While some people think that immediate and aggressive federal involvement is the best answer, some parts of the country have made progress with just establishing firm medical guidelines for doctors -- one of those areas is Washington State. This effort made by Washington State was a concerted one to address and reduce the number of injured-worker related deaths in part related to the bolstering rise of opioid medication prescribed (Ceniceros, 2012). "Among other measures, Washington's guideline recommends that doctors not increase opioid doses beyond an average daily morphine equivalent of 120 milligrams when a patient does not demonstrate improved functionality and decreased pain at lower doses or without first consulting with a pain management expert" (Ceniceros, 2012). This is just one example of some of the guidelines being put forth in this new effort to curb the fatalities and addictions that have arisen as a result of extreme opioid use. While there will always be critics of this movement, the majority of experts and professionalism Washington state have applauded their efforts when other states have really done nothing to adequately impact the problem.

And the problem is indeed severe: "They say such guidelines are called for because workers with relatively minor workplace injuries are ending up addicted or dying from overdoses. 'It's one of the most tragic outcomes in work comp,' said Robert J. Malooly, former assistant director for the Washington State Department of Labor & Industries' Insurance Services Division and current CEO of Claim Maps L.L.C. In Olympia, Wash. 'Someone comes in with a back sprain that otherwise would have resolved on its own and they wind up dying of an overdose'" (Ceniceros, 2012). This quote most lucidly demonstrates the ludicrousness of the issue and how incredibly preventable opioid-addiction and opioid-related deaths are. It appears as though the bulk of the opioid prescriptions are occurring unnecessarily and people are dying because of the thoughtless and other-wised poorly motivated decisions of doctors. Even a layperson would know that attempting to use opioids on a back sprain is far, far too heavy handed. No doubt, guidelines like these might have to turn into stricter laws and regulations as put forth by the federal government if medical professionals ignore them, and the numbers of addictions and fatalities don't decrease steadily and quickly.

However, future directions of this issue also need to address an adequate solution for helping those who have become dependent on this drug. For example, some of the parties involved in the enabling of addiction are creating a team approach to help those people who have become addicted. "Insurers, brokers and third-party administrators say they're working with primary physicians to help wean claimants off Schedule II narcotics, such as oxycodone and methadone, if they start to develop a dangerous dependence on such drugs. Some companies also are creating strategies to assist workers who already have become hooked in hopes of preventing opioid overdoses and deaths, as well as containing medical claim costs" (Harrison, 2011). More and more employers realize that there needs to be a greater amount of intervention during the early stages of opioid prescribing and consumption; certain insurance companies are creating things like "peer-to-peer doctor reviews as a way of circumventing addiction problems before they become too serious, uncontrolled or begin to wage serious physical and psychological damage on the employee.

Thus, these endeavors all represent a solid start to curbing opioid addiction, but perhaps the greatest amount of change will be observed when stricter, nationwide regulations are in place. This is a grave problem and one which the workers of this country are dearly paying for. The government has a duty to monitor and restrict the corruption and greed which is in place and which is largely responsible for this problem.