A Call for Worker-Centered Research in Workers' Compensation

R EFORM. FROM HEALTH CARE AND EDUCAtion to welfare and criminal justice, calls for reform have galvanized the public and focused the attention of legislators and policy make 'S at both federal and state levels. Add Workers' Compensation (WC) to the laundry list of systems or programs in need of reform. States are falling all over each other in their efforts to address the uniformly acknowledged crisis in Workers' Compensation. Views about what constitutes the crisis and what it will take to manage or handle it seem to vary, although it is widely held that out-of-control costs are at the heart of the crisis. And there seems to be evidence to support this view. Costs have certainly increased over the decades. Between 1972 and 1992, costs grew from $6 billion to $62 billion, reflecting a growth rate of 12.5percent per year. <Burton, 1993a) There is not a lot of research in the area of Workers' Compensation, but the little that does exist relates primarily to cost. One can read about cost-drivers, costconsequences, cost-containment, and the impact of x (or y or z) on costs. Reform-minded state policy makers often are swayed by the cost data presented to them and by other arguments (or threats) made without the benefit of evidence or data -loss of a "favorable" business climate, loss of jobs, decreased competitiveness, rampant fraud and abuse. Reforming the system to address these problems appears to be a win-win proposition for legislators, employers, and many members of the voting public, most of whom have had little if any experience with the Workers' Compensation system. Few would argue that the Workers' Compensation system does not need fixing. The problem is that the "fix" is directed primarily at cost control, and that the easiest and most direct way jo contl:9lco~tsis to reduce benefits or otherwise limit compensability. Never mind that the system was developed to help injured workers and that WC reforms are principally framed to address the cost concerns of employers and insurers. Never mind that WC researchers have failed to put the needs of injured workers on their research agendas or that system inequities and inadequacies continue to exist more than 20 years after the National Commission on State Workmen's [sic] Compensation Laws issued its recommendations for reform. (National Commission, 1972) Never mind that we know little about how injured workers and their families fare in the system or even if the system functions to their benefit. Nor do we really know how well the system performs in meeting some of its other objectives, such as providing incentives for workplace safety and rehabilitating injured workers up to a meaningful level of function. The time is right to take a good look at the system. State reforms show no sign of abating and, at the very least, they should be evaluated on many parameters. Recent federal and state health care reform proposals have suggested some sort of "merger" with the Workers' Compensation system; this demands a full and fair critique of the current system. Research and evaluation are sorely needed, and there is no paucity of researchable questions for the various stakeholders involved in Workers' Compensation. (G. Shor, 1994) But we must ensure that the needs and concerns of injured workers are included in the marketplace of ideas and questions about Workers' Compensation. We need to expand the focus of research in this field. We need worker-eentered research, that is, research that focuses on the needs and concernsof injured workers. Employers and Workers' Compensation insurers have had this kind of focused assistance in addressing their concerns. Researchers have, in the main, framed their questions and generated information around the cost-based concerns of employers and insurers, who, incidentally, fund most of the research in this area. But cost is not the only issue in a system that fundamentally