State Level Activities
State Leadership Activities
Program Goal Areas
Policy Information Pipeline
WORKERS' COMPENSATION: AN OLD MODEL REVISITED
by John Allen, Professor of Law
With 50 different laws across the country, it can be difficult to make universal statements about workers' compensation law but there are some safe generalizations. The laws are intended to create a system by which individuals who are injured in connection with their work are provided a cash benefit and medical care. These benefits are paid for by the employer, typically through insurance written specifically to meet the obligations imposed by the state workers' compensation statute. The laws work an exchange: the injured employee receives benefits, but gives up the right to sue the employer.
The great majority of employees in this country are covered by workers' compensation laws. As of 1989, 87% of workers were covered. Some statutes exclude domestic employees, agricultural workers, and small firms.
All states require the provision of medical and hospital benefits, including "artificial members and aids". A number of interesting cases concerning assistive technology have arisen in connection with this obligation:
The plaintiff in Squeo had quadriplegia, the consequence of a fall from a roof while working. The New Jersey statute required the provision of "medical, surgical or other treatment necessary to cure or relieve" the work-related injury, as well as other "appliances" to "restore the functions of the injured member or organ". The plaintiff sought payment for a self-contained apartment attached to the home of his parents, at a cost in excess of $65,000. The court found the expense to be "necessary" and "reasonable" and affirmed the order requiring payment for the construction of the apartment.
The plaintiff was involved in a motor vehicle accident while working, resulting in a broken neck and quadriplegia. The Iowa statute required the provision of medical care and "reasonable and necessary crutches, artificial members and appliances..." Mr. Ciha sought various home modifications, including widened doorways, a ramp, a special shower and an elevator to accommodate his use of a wheelchair. In addition, he sought the expenses of modifications to a van. Although the employer agreed to provide a wheelchair, it refused to provide the home and van modifications.
The Iowa Supreme Court affirmed the state workers' compensation agency's order that the employer pay for the home and van modifications. The court held that the modifications were "appliances", which the Iowa law defined to include any "artificial device used to provide function or for therapeutic purposes". The court viewed the modifications as designed to provide "function" for Mr. Ciha, concluding: "we believe the specific home modifications and van conversion are merely an extension of Ciha's wheelchair". As support, the court cited its earlier decision in Manpower Temporary Services v. Sioson, where the court held that a modified van is "not greatly different from crutches or a wheelchair", and that a van can be necessary to make a wheelchair "fully useful".
In this case, the claimant lost both legs in an accident. His physician recommended swimming for needed cardiovascular exercise. The court affirmed an award of the costs of constructing an in-ground pool.
In this case, the claimant injured his back. The claimant weighed 422 pounds, and his physician recommended losing weight to facilitate recovery from his injuries. The claimant sought payment for admission to an in-patient weight loss clinic. The court held that it was appropriate to require payment for the treatment of a condition that must be treated in order to relieve the effects of the industrial injury. The court considered the treatment to be "medical" in nature.
It is worth exploring the possibility of importing this emphasis on function into other health care systems. The focus of health insurance has been, historically, on curative and palliative care. Any assessment of the quality of "health", however, must include consideration of function. The workers' compensation system, while relatively old, can provide a new model for thinking about what it means to provide "health care".