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.  

Is it becoming easier or more difficult to accommodate persons with disabilities?

I  recently spoke to the  Healthcare Professionals Conference hosted by WorkSafeBC.   My presentation outlined the dramatic demographic factors that are changing –and will continue to change-- our healthcare systems, workplace and communities.  Several presentations focused on the issue of mental injuries, stress, and the duty to accommodate.  A few years ago, conference planners would have confined these topics to a breakout session under an obscure title in an inconvenient time slot.  Not so today!  That may be a sign of progress… or desperation.

Accommodation is primary disability prevention.  Statutes that codify an employer’s duty to accommodate have been around for years.  Employers, disability management professionals and human resource policy makers know the law and what it means.  Whether the specific law, rule or regulation is under Human Rights legislation, the Americans With Disabilities Act (ADA), or a workers’ compensation statute, most medium to large organizations are aware of the duty to accommodate.  They train their managers and likely have supervisors and union leaders with a common understanding—at least for the more common physical disabilities. 

We also have many high-profile examples of persons with disabilities excelling in sports, politics, science, and medicine.  These examples are changing perceptions and awareness.  Although many workplaces have had to make few accommodations, most workers and managers would see both the legal and moral imperative behind the duty to accommodate.  More importantly, they see the value and potential of the individual person rather than the stigma of the impairment.  Having role models and seeing more co-workers accommodated will continue to make accommodation easier.  There may be no hardship involved in accommodating if the environmental barriers no longer exist.  If accommodation is not needed, then the impairment is not likely a workplace disability. 

Technology is further enabling that potential.  Driverless cars, bionic hearing implants, thought-to-input devices, exoskeletons, and many other technologies are lessening the impact of physical impairments.  Our concept of “disability” is changing and our ability to accommodate is being enhanced.  Few would argue that the cost of providing technological aids would constitute an undue hardship.  Technology is making accommodation easier and, in some cases, costless or productivity enhancing to implement.    

Accommodations are not restricted to technological interventions.  There continue to be real barriers to accommodation of persons with psychological or mental conditions and impairments.  Persons with degenerative (Parkinson’s, certain cancers) and episodic conditions (epilepsy, migraines) are also harder to accommodate.  Whether because of fear or ignorance, co-worker or customer attitudes can be significant and continuing barriers.  How effectively are we accommodating persons with severe Turret’s ticks, schizophrenia, recurrent depression, post-traumatic stress disorder? 

Even industries with low injury rates may find it increasingly more difficult to accommodate workers with certain conditions as the prevalence of those already accommodated becomes significant in a department or organization.  Several employers have commented to me that past compliance with mandatory-reinstatement provisions leads to incrementally more difficult accommodation challenges for each new case.  These employers perceive the duty to accommodate as becoming more difficult.  

It may not have reached the point of “undue hardship” but is clearly a concern. 

One employer noted that about half the staff in her operation had one or more accommodations (some temporary because of recent work-related injuries, others permanent because of permanent work and non-work related impairments).  She was happy to support each individual but her concern over the increasing costs and declining competitiveness were obvious.  As more of the certain job requirements were concentrated on fewer non-accommodated staff members, she was concerned about increased risk of injury and the potential for resentment and increased risk in this group of workers. 

Is accommodation become more or less challenging?   The answer is both!  And that situation is likely to continue for some time.  With increasing numbers of older workers, the conditions and co-morbidity associated with ageing will become more prevalent.  The demand for certain skills in short supply may drive an increased “desire to accommodate” as the price of attracting or retaining certain expertise.  Innovation will also be required, not just to adapt and apply new technologies but also to reorganize the way work itself is performed. 

The question itself, however, masks the reality of work environment.  The prevalence of persons with impairments that need accommodation is increasing and will continue to increase in our workplaces.  The biggest barriers to future accommodation are less likely to be the undue hardship of a technological aid.  Attitudes, static organizational structures and persistent prejudices are likely to continue to be the biggest barriers in the coming years.     

What is an employer "duty"?

Duty.  It’s a word we don’t use that often in the context of workers’ compensation and occupational health and safety.  When we do use it, we tend to gloss over it and may miss its real meaning and importance. 

Employers have a “General Duty”  to protect workers in the work place.  Every occupational safety and health regulation has a General Duty Clause.  The US OSH Act specifies it this way (in part): 

SEC. 5. Duties(a) Each employer --

                (1) shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees…

WorkSafeBC’s governing legislation uses similar terms and stated (in part) in section 115 of the Workers Compensation Act:

(1) Every employer must  (a) ensure the health and safety of

(i) all workers working for that employer, and

(ii) any other workers present at a workplace at which that employer's work is being carried out

Employers also have a “Duty to Accommodate”.  This duty may emanate from Human Rights legislation but may also be reflected in workers’ compensation legislation  (often in the form of a Mandatory Reinstatement provision).  Ontario’s Workplace Safety and Insurance Act, 1997 states both an “obligation” and a “Duty”

Obligation to re-employ41.  (1)  The employer of a worker who has been unable to work as a result of an injury and who, on the date of the injury, had been employed continuously for at least one year by the employer shall offer to re-employ the worker in accordance with this section.

Duty to accommodate(6)  The employer shall accommodate the work or the workplace for the worker to the extent that the accommodation does not cause the employer undue hardship.

The Victorian WorkCover Authority  (and others) use the term “duty-holder” – a term that is useful in conceptualizing that a duty has substance.  It also implies that someone, some individual or group is “carrying the ball” and that its possession may be “shared with” or “passed to” someone else but not dropped or abandoned. 

In common usage, “duty” has a stronger connotation than “responsibility” or even “obligation”.  We often read or hear that someone “ignored”  or “shirked” a responsibility or “walked away” from an obligation but we speak of “dereliction”  or  “failure” when referring to a duty unfulfilled. 

This sense of a duty being a mandatory obligation or moral requirement reinforces the importance of the General Duty, the Duty to Accommodate and other duties in workers’ compensation and OH&S; the specificity of the term “duty-holder” helps underscore the persistence of that obligation and the potential consequences that may flow from abandoning  or consciously neglecting to act. 

There are other “duties” in workers’ compensation,  OH&S, and our broader community.  Some are specified in legislation but others  are part of the moral framework of our society. Healthcare workers have a “duty of care”, injured workers have a “duty to mitigate loss”,  all of us have a “duty to provide the necessities of life” to children and others.  

A duty imposes a moral obligation on the duty-holder  to act.  Recognizing this relationship may help employers, workers and others in the workplace ensure every duty and duty-holder understands what is required and acts accordingly.

How does health, safety and workers’ comp measure up in China?

The digital display registered 431 km/hour. The Shanghai landscape flashed by the window of the worlds’ only Magnetic Levitation (Mag Lev) commuter train. Safe, fast, economical—the MagLev is emblematic of the “new” China and of the inherent consideration for occupational health and safety that is essential to its design, construction and operation.

For any observer sensitive to safety, China offers ample opportunity to examine safety systems as they apply to old technology, massive urban renewal projects, and advanced technological installation such as the MagLev . There are obvious similarities and striking differences in safety protocols and standards from what we see in the West. Whether observing a construction projects in the growing hospitality sector in the rice-terraced hills of Longji (Guilin) or in the inner precincts of the walled city of Xi’an, practices that protect workers from harm are inherent in the processes and procedures.

Watching a welder on a new high rise in Shanghai, I could see virtually no differences in the protections evident from those I have seen in any western metropolis. The worker, his equipment and the safety environment around him were equivalent to what I have seen in Vancouver, Melbourne and New York. I noted many co-workers wearing hardhats (all with engaged chin straps) working behind guardrails floor after floor, in much the same way observed in Western centres.

In the mountainous rice terraces of Longji, a lone construction worker in soft shoes and no hard hat was slowly, methodically, building a brick wall between concrete pillars of a third floor of a cliff-topping guest house. Clearly, not what might be seen adhering to western safety standards; yet, when I speak with the locals (many have some English in part because of the tourism in the area), they report few injuries. Without personal protective gear like hardhats and steel toed boots, workers carry out complex tasks without excessive injuries. How can this be? When I asked one local engineer why injuries were not more common, he attributed the relative safety he observed to “the Chinese way of doing things”.

There is a tendency to confer the qualifier of “safe” on the visible protections observed in a workplace. Hard hats, fall arrest systems, safety googles are obvious examples. Such apparatus, however, are but one layer of protection. The barriers or safeguards that protect workers from the inherent active and latent hazards in the workplace are not always as visible as personal protective equipment (PPE). For example, much of what I observed in China was extremely patterned work. Many buildings were not unique. The design and methods used to create them were very standardized. Many of the workers were evidently very experienced. In essence, one observed experienced workers, building nearly identical structures with the time-proven methods. These “systems” of doing things embody worker protections in the designs, work procedures and shared culture.

Workplaces around the world rely on these less visible, less “prescribed” worker protections. Barriers, safeguards and defenses that protect workers extend well beyond the visible personal (and most immediate level) of PPE; one can see safety in the design, work processes, supervision and training (and experience). Are these enough? Probably not…in China or anywhere else; in China as in the West, all work generates hazards to workers. The challenge is the same in every workplace: managing the risks and reducing the frequency and magnitude of the defects in the barriers, safeguards and defenses that protect workers from occupational injury and disease.

Work-related injuries occur in China as they do in the West, so security in form of compensation and rehabilitation are also needed. According to the ILO, China has effective employment-injury coverage for about 22.5% of the labour force (World Social Protection Report 2014/15 ). This is low by European , Australian and North American standards but this is double what it was about a decade ago. And the mandated coverage provides innovative incentives toward safety and prevention. For certain degrees of disability, the accident employer must provide suitable employment –something like the mandatory reinstatement provisions present in some workers’ compensation legislation. The Chinese solution, however, goes further. It anticipates that reinstatement may not be possible so mandates the employer pay a pension equal to 60 per cent or more of the monthly net income of the injured worker.

Challenges still exist, of course. Demographic, political, economic and environmental challenges will continue to test China’s people and leadership. The care and protection of the most vulnerable in the labour force and society must continue to be a priority in China as they are with other nations.
That said, China is changing. Its economy continues to lead the global recovery. Its technological advances are often leapfrogging the incremental paths other nations have taken. Hopefully, the safety and health of workers as well as their care and support after injury will continue to be part of China’s agenda.

What are the OH&S / Workers' Comp implications of "Voluntary" events and activities?

Workers are often asked to “volunteer” for certain activities that have some association to employment.  The association may be strong (volunteering for overtime) or weak (attending a company picnic) but there are implications for safety and health as well as workers’ compensation. 

Most volunteering” cases involve a worker working on a special project, putting in overtime to clear a backlog, or participating in a special events like conferences, open houses, or community event (parade, “home and garden” show, cultural festival) .  The connection to work in these examples is pretty clear.  A worker may volunteer to participate in these activities and events but injuries that may arise out of and in the course of these events are as work-related and typically accepted as compensable in most jurisdictions. 

This coverage is an important protection for workers and employers. Workers continue to have access to the workers’ compensation coverage for themselves and their families; workers’ compensation coverage protects employers from suit for work-related injuries that may arise.  If the voluntary event were not deemed work-related, the employer might still be faced with liabilities in the event of injury. 

Just because a voluntary event or activity such as working to clear a backlog may be covered by workers’ compensation does not mean an employer can forget about health and safety.  Occupational health and safety standards still apply.  Before initiating a voluntary weekend shift to clear a backlog or asking someone to pull an “all-nighter” to prepare a presentation for the next morning, an employer needs to ask questions about health and safety like:

•  Are the protections normally provided available to the worker(s)?
•  Are there special risks or hazards associated with this work that need to be identified? 
• If the worker is working alone, what provisions are required and in place for his or her protection?

Suppose there is a big order due out on Monday and you ask for “volunteers” to work the weekend to fulfill the commitment.  Are the usual weekday resources for the health and safety of the workers available on the weekend?  Is there access to a qualified first aid attendant, open lunch area, alarm and production stops working, etc.? Does the week-end site security system change the risk of intrusion?  Are there scheduled maintenance activities such as floor washing and waxing or system purging that could increase risks to those not normally on site when these activities take place?

And then there are the “voluntary events” like corporate picnics, softball tournaments and project celebration parties.  Are these truly voluntary or are they “work-related”?  Depending on the jurisdiction and the circumstances, injuries arising from participation in such events may well be compensable.  Each case will be determined on its own merits but adjudicators tend to look at the expectations for attendance, where the event takes place, how involved the employer is in sponsoring the event, and the degree to which the activity or event furthers the objectives of the organization. 

Expectations for attendance and participation are tricky.  A worker may feel compelled to participate particularly if the firm organizing or sponsoring the activity promotes it as a “team-building” event or if there is an implied advantage or accepted requirement of participation as part of career development.  Failing to participate may be what we used to call a “career-limiting” decision.   Is a participant really “free” to choose non-attendance in the event?

Employer benefits such as improved worker health and morale, higher corporate profile, and better standing in the community may be enough to bring an event into the scope of “work-related” activities.  One can imagine photographs of the event or activity published on intranet sites and used in recruiting brochures as evidence of corporate social responsibility and accountability—an important corporate goal. 

If you want to enhance trust among team members, you might organize a rock-climbing event.  A day of river rafting may help an executive team bond, refresh and foster creativity.  Having teachers/faculty voluntarily attend graduation ceremonies, homecoming, and alumni events clearly advances the interests of the school, college or university.  The “work-relatedness” of any of these events may be sufficient to bring injuries that may occur into the scope of workers’ compensation coverage.

My point is not to discourage corporations from offering such events and activities.  These activities can clearly further the corporate objectives.  When arranging, sponsoring or organizing any corporate activity and event, be aware of its “work-relatedness”, have your health and safety professional look at the hazards that may be inherent in the activity, venue, or event,  and ensure compliance with occupational safety and health standards. 

How does the workers' compensation scope of coverage influence the OH&S mandate?

Governments implement legislation to fulfill a specific societal desire or “social policy objective”.   One social policy objective is:

to protect workers from work-related injury, disability, illness and death in a compassionate and sustainable way that still allows the economic activity and innovation necessary for societies to operate and thrive.

The statutes created by legislators to achieve that objective vary.  There is, however,  a set of “levers” that can be used to achieve the objective .  Governments create “statutory agencies” to control the levers.  Where the percentage of “employed labour-force”  covered by workers’ compensation approaches 100%, it makes sense to place all the levers of control in the hands of a single statutory body that can set, adjust, and fine-tune the levers to achieve the social policy objective.  This is exactly what we find in practice in Canada. 

The following table is based on data from the Association of Workers’ Compensation Boards of Canada (AWCBC.org):

For the statutory agencies near the top of the list, the workers ’ compensation board of commission generally controls all the levers (workers’ compensation and OH&S).  In jurisdictions towards the bottom of the list, workers’ compensation levers can have no impact on those outside the scope of coverage.  The ability of one  statutory agency  to fine tune or set the full range of levers  for the part of the labour force not covered is lost. 

In order to achieve consistency across the economy, jurisdictions with low percentages of employed labour force covered must struggle to achieve the social policy objective with only half the tool set  for those outside the scope of coverage.  The need for consistency across all workplaces, however, requires the enforcement, regulation, education/training and prevention levers  that influence the health and safety outcomes in the workplace be applied (largely) independently from what happens in workplaces within the scope of workers’ compensation coverage.  The tool set that can be used by the statutory agency responsible for OH&S  is restricted.  To achieve the social policy objective, the incentives tend to be more “stick” oriented (including increased use of prosecution and fines).

The statutory agencies responsible for workers’ compensation in these low-coverage jurisdictions have a limited tool set as well.  Often, this spawns more aggressive use of  the levers within its exclusive control like experience rating, classifications, surcharges, discounts and other  incentives (including retrospective rating systems and rebates).  This dichotomy—even in the presence of extensive consultation—can result in perverse outcomes including claim suppression. 

There may be other social policy reasons to decide to exclude significant portions of the employed labour force from workers’ compensation coverage.  It is up to each jurisdiction to determine if some other objective is of greater importance to justify that exclusion.  There is nothing inherently wrong with doing so.  It is up to the constituency of each jurisdiction to determine its own priorities.  My point is simply that decisions on the scope of coverage for workers’ compensation systems have consequences for workers and employers both inside and outside the scope of coverage.  It also has consequences for the range and precision of the levers that can be applied and coordinated to achieve safe and healthy workplaces in a thriving economy.  

What is the "social policy objective" of workers' compensation?

There is no shortage of work for those of us connected with workers’ compensation and occupational health & safety (OH&S).  People continue to get hurt, develop disease and even die as a result of work-related activity.  Investigating injuries, adjudicating claims, caring for victims and families while reducing and eliminating the causes to prevent future occurrences are the obvious “reasons” behind what we do.   Exactly how we organize and what we do vary greatly with the jurisdictions in which we work.  Virtually every developed and developing nation has systems and organizations that deliver workers’ compensation and OH&S services.  So, what is the underlying “social policy objective” each society is trying to address?

The ubiquity of workers’ compensation and OH&S public policies reflect an underlying and universal social policy objective:  to protect workers from work-related injury, disability, illness and death in a compassionate and sustainable way that still allows the economic activity and innovation necessary for societies to operate and thrive.  This social policy objective recognizes that all human activity takes place in the presence of hazards to the health and safety of individual workers.  It also recognizes societal expectations that a vibrant economy is desirable. 

In deciding how to achieve this social policy objective, legislators have a series of direct and indirect levers they can adjust that will impact workers, employers, work activities and work processes.  These control mechanisms cluster under the general headings of workers’ compensation and OH&S. 

On the workers’ compensation side, legislators can determine the scope of coverage—both who and what will be covered.  Making workers’ compensation coverage mandatory imposes a cost on firms and an oversight obligation on behalf of authorities.  Premiums can be modulated to achieve effects.  Bringing hearing loss into the scope of workers’ compensation, for example, increases compensation costs and therefore premiums.  The increased premiums can provide an incentive for reducing noise induced hearing loss in the workplace.  The same argument may be made for mental injuries and illnesses due to stress and bullying.  Bringing these outcomes into the scope of workers’ compensation can certainly provide an incentive for prevention.   Experience rating (also called experience modification) is another lever that can be fine-tuned to apply economic pressure to firms with greater frequency or claims costs.  To mitigate costs, greater investment in prevention and rehabilitation/return-to-work and work accommodations are the typical workplace responses.  Other incentives including retrospective rating, rebates and discounts for specific prevention or RTW initiatives round out the control panel on the workers’ compensation side.

On the OH&S side, there are four main levers:  regulation, enforcement, education/consultation, “prevention” promotion.  The regulation lever can be set widely or narrowly and adjusted towards being more prescriptive or performance based.   All regulation has a cost in terms of the freedom of an enterprise to extract economic gains from a process.  Whereas workers’ compensation policies will impose costs associated with injuries to the firm, regulation on the OH&S side may increase production costs but prevent injuries or exposures that would lead to workers’ compensation claims. 

The enforcement lever can be set with respect to intensity and severity.  Who gets inspected , how often and with what consequences (financial penalty, stop work order, etc.) are the main policy desisions.  The effectiveness of this control for well-performing firms is really not an issue.  For poor performers who ought to know better, the enforcement lever will only be effective if set to level where the expected cost of detection (financial and reputational) of regulatory violation  exceeds the expected value of gains possible by violating the regulation.   

The education/consultation control  has little impact on high-performance organizations (they already know and do what needs to be done).  For workplaces who do not know or who have a new or difficult safety or health issues, increasing resources and efforts in this area can be effective. 

Finally, the prevention promotion lever can be set broadly or narrowly but lacks precision.  It is great for increasing awareness and shifting attitudes at a societal or sectoral population (health care workers, welders for example) level but requires sustained exposure to target audiences to achieve intended results. 

Those are the levers that legislators have to achieve the social policy objective.  Legislators typically delegate the authority to set and adjust the controls to commissions, statutory agencies or other bodies.  Often, feedback mechanisms or oversight agencies or reports are also mandated to determine the performance of the system in achieving the social policy objective. 

My own view is that these levers must be operated in concert.  The setting of each control has an impact on the overall movement toward the desired objective.  Where the scope of what is covered is wide and the percentage of employed labour force covered is high, it makes sense to create statutory structures with the high degree of control over all the levers that can impact the social policy objective.