Masonry Magazine August 1986 Page. 22
PART II
THE BASICS OF
WORKERS COMPENSATION
Workers compensation insurance is one of the most important insurance coverages in the United States. More than $18 billion of this coverage was written by insurance companies last year to protect employees via benefits to injured or ill workers for hospital and medical care and vocational and physical rehabilitation.
Although many workers and employers are aware that workers compensation exists and that benefits are provided, there probably is a lack of understanding about the basics of workers compensation and some of the principal issues impacting on the system at this time. For this reason, the National Council on Compensation Insurance (NCCI) a national organization headquarterd in New York City which develops and administers rating plans and systems for workers compensation insurance has prepared the following article dealing with various aspects of this coverage. The information should be of special interest to employers because, among other things, it includes explanations of how workers compensation rates are determined and how premium savings can be realized by employers with good safety records.
A Brief Look at Occupational
Disease
We have known for a long time that certain occupations expose workers to diseases, and that these diseases are caused by the job. Perhaps the best known occupational disease is black lung, the affliction of coal miners. Few coal miners are entirely free of black lung, but few noncoal miners ever contract it.
There are other occupational diseases readily associated with a particular industry, but many others are more ambiguous. Not only is there cause less easily tied to the workplace, but even when some connection can be found, the worker's personal habits may play an important role in his or her condition.
For example, there are a number of industries and industrial processes that can lead to lung and respiratory ailments, but these same complaints can be brought about by smoking. When a worker in an industry vulnerable to such diseases is also a smoker, the problem of assigning causation to the disease, a critical part of compensating it, becomes complicated.
No dramatic event heralds the onset of occupational disease claims; they are not, as a rule, brought about by the sudden, traumatic injury characteristic of most workers compensation claims. Chances are the claimant will go for some time suspecting that something is wrong, eventually visiting a doctor who will confirm it.
Once the disease-based disability has been discovered, the disease must then be identified as the cause of the disability. The question of causation is a question of fact and will usually be resolved by the presentation of medical evidence to the authority in the state (these are usually workers compensation boards or courts, but will vary by state) charged with making such determinations.
Finally, when the disease has been identified, the claimant must demonstrate that it was contracted through the nature of the employment. Some states specifically list occupational diseases in the workers compensation statute itself. These listings may also describe the industrial process that usually gives rise to the disease. If the employee's disability matches those described in the statute, of course, proof of its connection to the workplace is simple.
However, not all diseases or industrial processes are specified, and most states have a catch-all provision similar to New York's, including "any and all occupational diseases" caused by employment. The occupational disease laws, however, are generally limited to those diseases based on hazards encountered in the employment. This is an important distinction; they do not cover every disease that an employee might contract while on the job, but rather those conditions specific to the business, "... which produce the disease as a natural incident of a particular occupation, [attaching) to that occupation a hazard which distinguishes it from the usual run of occupations and in excess of the hazard attending employment in general," as defined by New York's Court of Appeals.
Put another way, even though an employee contracts a cold on the job (assuming, of course, that the cold disabled him, which we will do for the sake of example), he would not be able to claim an occupational disease. The purpose of this distinction is clear-to separate those disabling diseases brought about by employment in a particular industry from those diseases incidental to the run of human life. Workers compensation is designed to assist workers in recovery from or living with occupational in-