Wednesday, October 15, 2014

Why is there a waiting period for workers' compensation?

Many workers’ compensation jurisdictions have a “waiting period” for workers’ compensation.  This is a form of “deductible” whereby the worker absorbs the initial financial impact of wages lost due to a work-related injury.  Most jurisdictions with a waiting period also have a “retroactive period”; if a claim extends to or beyond the retroactive period, workers’ compensation for temporary disability during the waiting period is compensated.  There are also a number of jurisdictions that “waive” or “exempt” certain injuries or occupations from waiting periods. 

Waiting periods are not universal.  They are absent from most workers’ compensation systems in Australia and Canada.  In the US, waiting periods are common.  When John Burton wrote the National Commission on State Workers’ Compensation Laws (Washington, DC July 1972), he summarized the rationale for waiting periods and recommended the upper limits for waiting periods and retroactive provisions.  Specifically, the report’s Introduction and Summary notes on page 18:

Waiting period [Section 27(d)( 1 )(H) ] . Recommendations published by the Department of Labor propose a 3 day waiting period and a 14 day retroactive period. In contrast, the Model Act of the Council of State Governments specifies a 7 day waiting period and a 28 day retroactive period. Most States meet the standard of the Model Act, but do not meet the Department of Labor recommendation. Although the Model Act would provide benefits for 83 percent of lost time, the U.S. Department of Labor standard would compensate for 93 percent. The purpose of the waiting and retroactive provisions are to reduce payments for truly minor incidents and to assure benefits for even moderately serious injuries.

 We recommend that the waiting period be no more than 3 days and that the retroactive period be no more than 14 days. (See R3.5)
 
Using the National Commission recommendation as a basis for judgement, only 17 of 51 US jurisdictions would meet or exceed the recommendation regarding the length of the waiting period and retroactive period; all twelve Canadian jurisdictions would meet the waiting period recommendation but three would fail to meet the recommended retroactive upper limit.  The accompanying table reports the waiting period and retroactive period provisions in the US and Canada and assesses these against the National Commission’s recommendation. 

Interestingly, back in 1916 when British Columbia was considering its entry into workers’ compensation, the committee of the legislature (under Avard Pineo), the waiting period was avidly discussed.  The BC committee opted for a 3 day waiting period based on the following reasoning: 

We think that a waiting period of three days applicable in all cases will be adequate to accomplish any proper purpose sought by those who advocate the necessity of a waiting period, but will not be found to seriously inconvenience the injured workman, especially as he is during this period provided with full and adequate medical aid.http://www.worksafebc.com/publications/reports/historical_reports/pineo_report/default.asp

While the trade-off in 1916 was a three-day waiting period for the best medical aid provision in workers’ compensation at the time, many critics felt the burden of the waiting period was still considerable. The three day waiting period would be supported by three Royal Commissions in BC (Sloan 1942, Sloan 1952, and Tysoe 1966).  In the 1966 Royal Commission in British Columbia, Justice Tysoe sided with the business community and recommended continuation of the three day waiting period because of a fear of the financial impact on business if it were eliminated.  The government adopted that recommendation but in 1972, in the lead up to an election, the government of the day eliminated the waiting period.  

The most recent Royal Commission in British Columbia (1999) closely examined waiting periods.  It heard a number of reasons why a waiting period might be considered.  Reducing employer costs was one but concerns over “moral hazard” and high administrative costs were also noted.  The Royal Commission concluded:

Waiting periods do not reduce the costs of workplace injuries unless legislation and policies promote conduct by employers and workers that results in a real reduction in the number of injuries and illnesses, or a reduction in frivolous claims which would otherwise have occupied adjudicators’ time. If real costs are not being reduced, then waiting periods are simply a means for shifting costs away from the workers’ compensation system and onto individual workers, employers, or both.

The commission does not consider the latter an appropriate objective or result. The commission’s examination of the limited empirical evidence on waiting periods leads to the conclusion that any cost savings associated with waiting periods due to reductions in claims volume may well be more than offset by increases in the average costs of the remaining compensation claims, due to the extension of work absences beyond the waiting period (or beyond the retroactive period if one is introduced). 

Therefore, the commission sees no compelling reason to extend the current waiting period [the day following the day of injury], and in fact is of the view that injured workers should not be unfairly or unnecessarily denied compensation for losses caused by work-related injury.

Royal Commission on Workers’ Compensation in British Columbia Volume II Chapter 1 http://www.wcat.bc.ca/research/WorkSafeBC/WSBC_Hist_Rpt/1999-rc-report-2.pdf

There may be reasons why a state or province has a waiting period (and retroactive period) in its legislation.  The reasons, however, should be explicit and supported by research.  If the reasons are economic, then the economic magnitude of the policy should be measured.  I can find no current estimate of the “co-pay” or “deductible” portion of workers’ compensation born by workers who must serve an unrecompensed waiting period. 

If the reason for a waiting period provision is to discourage “frivolous claims”, then the central premise behind the argument is questionable.  Is any work-related injury “frivolous”?  Frivolous is a subjective judgement and hard to test from a research perspective.  All work injuries are serious and important in revealing failures in the barriers, safeguards and defenses that would protect workers from harm. 

There are other important questions that need to be examined.  Does the presence of a waiting period influence reporting of work-related injuries?  Is the duration of work-related injury disability influenced by the presence or absence of a waiting period?  What impact, if any, does the length of a waiting period and retroactive period have on recovery outcomes, worker satisfaction, or appeal activity?

Workers already must bear the human cost of work-related injury.  Quantifying the additional economic burden and other impacts of waiting periods and retroactive provisions should be on the research agenda.  


2 comments:

Jennifer Davies said...

It sounds like the waiting period isn't a particularly important part of worker's compensation. Is there any benefit to it? I don't see it as a problem as long as it's short enough that it doesn't hurt the injured party.
Jenn | http://www.workerscompensationvermont.com

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