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Virtually every industrialized country provides legislated entitlements to workers or their survivors to assist them in the event of an occupational injury or illness. Workers’ compensation systems are designed to ensure that the injured worker receives immediate medical care, and that the injured worker also receives prompt but limited benefits to replace lost wages. Workers’ compensation provides only part of the entitlement, with the rest—particularly for long-term disability—contributed indirectly through the country’s social security system. Workers’ compensation insurance assigns sure and predictable, “no-fault” liability to the employer.

Physicians and other health care providers who render care for work-related injuries and illnesses should understand the requirements of their jurisdiction’s workers’ compensation system. In addition to appropriate evaluation, diagnosis, and treatment, physicians are obligated to determine whether a worker’s injury or disease claim was specifically caused by work activity—a process that often engenders an adversarial relationship between the physician, the patient, and the responsible party, that is, the employer. Physicians must provide services efficiently because they are accountable not only to their patient (the injured or ill worker) to alleviate suffering and to ensure the flow of benefits, but also to the insurer and the employer to minimize disability, lost work time, and costs associated with occupational injury or illness.


The financial responsibility of the employer for the injury or death of an employee in the workplace was first established in Germany in 1884. Great Britain followed, in 1897, with legislation requiring employers to compensate employees or their survivors for an injury or death regardless of who was at fault. By the beginning of the twentieth century, all European countries had workers’ compensation laws.

The German law provided a model of workers’ compensation that was ultimately emulated by most European countries. The German system called for highly centralized administration of workers’ compensation claims and disbursements. It provided for accident prevention, medical treatment, and rehabilitation. Its coverage was broad and compulsory by all employers. The law mandated that the insurance be proffered to employers by nonprofit mutual employers’ insurance funds. The German system was closely linked to the rest of the nation’s social insurance system.

The British law embodied a substantively different approach. Participation by employers was elective, administration was left to the judicial system, and insurance was offered to employers through private firms. The British system was not linked to the nation’s social insurance system, and it did not provide for accident prevention, medical treatment, or rehabilitation. The British system was troubled from the outset by disputes over which jobs and what industries were to be covered, resulting in the very litigation that the law had been intended to replace.

There is a high degree of similarity between the basic criteria of the current workers’ compensation systems in all European countries. Some European social security systems provide universal coverage for ...

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