Lessons On Worker’s Comp: An Overlooked Part Of American Healthcare

By Dr. Robert Pearl, M.D.

Workers’ compensation was the nation’s earliest form of social insurance, originally covering federal workers in hazardous industries in 1908. Today, workers’ comp insurance covers 130 million employees whose wages total $6.5 trillion. The cost of coverage varies by state but, overall, it’s around 1% of payroll, or $450 per year per employee. In total, the dollars paid exceed $60 billion annually, with about half going to direct medical treatment and half toward lost wages.

This week, I had the chance to speak at the Comp Laude Awards & Gala, a nationally recognized workers’ compensation event in San Diego, which brings together experts on coverage and care to discuss issues of importance for employees injured on the job.

I was impressed that WorkCompCentral, the hosting organization and nation’s only digital publication reporting daily on the workers’ compensation industry, presented several awards to patients, something I’ve rarely seen in healthcare. Among those recognized were an individual who overcame opioid addiction, and a patient who had lost both legs in an accident and fought back to full activity. There’s something incredibly moving about patients who are able to recover from severe injury and addiction. And because the healing process never happens alone, these stories help remind those of us in healthcare why we chose medicine as our profession.

As part of the two-day event, WorkCompCentral invited me to participate in a fireside chat with Kimberly George, one of the organizers of the event and a senior healthcare advisor for Sedgwick. In our conversation, both Kimberly and I emphasized how the American healthcare system – with its great diversity of payers (government, private, commercial, etc.) – often cares more about who’s responsible for paying the bills than it does about the quality of medical care provided.

Workers’ compensation is a great example of this contradiction, and it reflects many of the same shortcomings highlighted in my book, Mistreated: Why We Think We’re Getting Good Healthcare–And Why We’re Usually Wrong. I’m amazed, for example, that employee health insurance is distinct from workers’ compensation in nearly all geographies, even though the medical problems are the same, be they musculoskeletal, psychological or cardiopulmonary.

Hurt your back lifting a box at work, and your care is provided through workers’ comp. Injure it lifting a box at home, and your care is paid through your usual insurance. Same medical problem, different insurance, and often different providers.

But regardless of whether an injury originates at work or at home, the goal has to be maximizing patient health and wellness. If that were the case, employee healthcare would be radically improved.

Consider that if someone injured on the job was given preventive services and ongoing help managing chronic diseases, both the employee and the employer would benefit. And if the worker’s personal physician oversaw and coordinated the care, the risk of an avoidable medical error would be greatly reduced. And why shouldn’t a person’s medical information be available through the same information technology system, regardless of how or where the injury occurred?

By combining the two types of coverage, the medical care itself would be better streamlined. Of course, industries vary and some are particularly dangerous: oil drilling, radiation safety and even parts of healthcare. But it makes little sense that companies should have to navigate these systems of care and coverage differently. The attorneys could still battle over workers’ compensation wages, but at least the doctors could provide one standard of medical care.

In doing so, some of the major abuses of the workers’ compensation system could be eliminated. It’s unlikely that all members of the audience at the Comp Laude event would agree with me, but I hope that all gained new insights from this important conference and left better prepared for the future.

Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s the bestselling author of “Mistreated: Why We Think We’re Getting Good Health Care–And Why We’re Usually Wrong” and a Stanford University professor. Follow him on Twitter @RobertPearlMD.


  1. Dr. Pearl,

    In my writing, I have said that there are two different silos, one for medical care under general health insurance, and one for medical care under workers' comp. We need to eliminate the two and bundle them into one silo. My blog, Transforming Workers' Comp, advocates for changes to workers' comp, including implementing international medical travel for better care and lower cost.


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