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Compensation of injured or disabled people or workers in this country has been administered mostly through the following systems:

1. Tort Law/Common Law Liability

2. State Workers' Compensation Systems

3. Social Security Program

4. Veterans Administration Benefits Program

5. Federal Employees Compensation Act (FECA)

6. Longshore and Harbor Workers' Act

7. Federal Black Lung Program

8. Federal Employers Liability Act (FELA)

9. Jones Act (Merchant Marine Act)

10. Private insurance and other private organizations

11. Americans with Disabilities Act (ADA)

12. Family Medical Leave Act (FMLA)


The identification of the casual link between the job and the injury or disease is very important in determining compensation - due to a work related or occupational illness, injury or disorder.

Political and legal climate quite often affects decision making on disability cases in the compensation systems.


The Social Security Disability Program is Public Law 74-271, the Social Security Act It is administered through the Social Security Administration as a national program. The initial process of disability determination is done at the state level through the Social Security Disability Determination services (Bureau of Disability Determination). The physician who would like to get involved in performing medical evaluations for Social Security can get referrals through the services at their state level.

An individual does not qualify for Social Security disability benefits merely because they cannot perform their usual occupation.

The Social Security Administration actually has two disability benefit programs, one is Social Security Disability Insurance Benefits and the other is Supplemental Security Income (SSI). Disability Insurance is under Title II, which provides for disabled persons who have contributed to the program through FICA (payroll) taxes. There is a minimum requirement that the individual must have worked a requisite number of calendar quarters. Benefits are financed by a payroll tax. This has risen from a rate of 2% at the inception of the program to more than 13% by the early 1980s. Supplemental Social Security Income is Titled XVI, and is funded through General Revenue. It provides benefits to eligible disabled persons who fall below a certain income or asset level.

According to Social Security Law, disability is "the inability to engage in any substantial gainful activity by reason of medically determinable physical or mental impairment that can be expected to result in death or can be expected to last for not less than 12 months." As can be seen, this definition is quite different from that of the AMA (see above).

The claimant for Social Security Disability Benefits has the burden of establishing by credible evidence that his impairments are indeed disabling.

The first step for a person to get Social Security Disability benefits is to file an application. The case is reviewed at the State Bureau of Disability Determination. The adjudicator at this level may decide to refer the claimant at the government's expense to a physician for medical evaluation. At the conclusion of the process, an initial determination whether the person is disabled or not is made. There are no partial benefits. The individual is either found disabled or not.


VA problems may provide both monetary and non-monetary assistance to eligible veterans.


The OWCP manages three Federal Workers' Compensation acts. Federal Employees Compensation Acts (FECA), the Longshore & Harbor Workers' Compensation Act, and the Federal Black Lung Program.


Civilian employees of the federal government are provided compensation benefits under FECA. A federal employee cannot sue the federal government or recover damages under any other statute for work related injury and resulting disability. Benefits under FECA are the sole remedy against the US government for work related injury or death.


This program is similar to FECA. It also excludes disability benefits for the brain, heart and back. It grants compensation benefits for disability or death to shoreside maritime employees. Mostly this acts covers any person engaged in maritime employment, including any longshoreman or other person engaged in longshoring operations, and any harbor worker including a ship repairman, builder and breaker.


The 1977 Federal Mine, Safety & Health Act, or the Federal Black Lung Program covers the coal miners whether they are surface or underground miners. It also covers the railroad workers who hauled coal, as well as other transportation workers including coal truck drivers. This Act provides monthly payments and medical treatment benefits to coal miners totally disabled from pneumoconiosis (black lung) arising from their employment in or around the nation's coal mines, and monthly payments to eligible surviving dependents. Present and former coal miners (including certain transportation and construction workers exposed to coal mine dust), and their surviving dependents (including surviving spouses, orphaned children, and totally dependent parents, brothers and sisters) may file claims.6 The Federal Black Lung Program is administered through the US Department of Labor which processes claims.


The Federal Employers Liability Act, or FELA, was enacted in 1908 and is the sole remedy for interstate railroad workers against their employers for job-related injury. Railroad employees must bring lawsuit in the State Civil Court or in Federal Court against the railroad if they cannot reach a settlement for the disability claim with their employer without litigation.

In order for the employee to prevail, the employee must prove in court that the railroad was negligent. There are no limits to the amount of awards: however, most FELA cases settled.


It is similar to FELA, and it covers civilian sailors while in the service of a ship or vessel in the navigable waters. Cases under the Jones Act are mostly settled out of court because courts are usually very liberal toward the seamen, considering them as a ward of the court.


The Americans with Disabilities Act enacted in 1992 prohibits employment discrimination based on disability. It compels the employers to employ the qualified individuals with disabilities who meet the essential functions of the job, requiring the employer to make the reasonable accommodations for a qualified person with a disability.

The accommodation is defined as a modification of the job or the workplace that enables a disabled employee to meet the same job demand as other employees in the same job or a similar job. Reasonable accommodation means something that would not cause undue hardship to the employer.

The purpose of this legislation was, in part, to assist individuals with disabilities to be able to be employed.


Private disability insurance policies usually state that the policy holder need only have his or her personal physician certify that they are disabled to start the benefits.


As a basic law, FMLA applies to employers of 50 or more employees. Employees must have worked for the employers for 12 months and at least 1,250 hours during the period before the leave request. Leave must be granted to both male and female employees for child birth, adoption, a care of immediate family and the employee's own illness.

Leaves are unpaid, but hospitalization and life insurance premiums must be continued while on leave.

The employer must designate the type of leave within two days of the leave request. That is, does it count toward the 12 weeks; is it regular sick leave or just time off? All such designations and limitations must be given to the employee in writing within two days of the leave.

The employer must spell out in writing all the specific terms of the leave, including regular certification from the physician, whether the employer can substitute other leave plans, the method the employee must use to pay for medical coverage premiums and under what conditions the employee will be restored to his/her original job. (Certain key employees may be permanently replaced during FMLA.)

On short-term leaves, the employers must ascertain each time whether the leave requested is under FMLA. If the employee declines to so designate the leave, the employer may elect either to declare it FMLA or not. Notices of the FMLA must be posted in a form that can be easily read.

The base period for calculating the 12month period must be spelled out in advance, such as calendar year, fiscal year, employee's anniversary date or a rolling 12month period starting when the employee first uses the leave. The employee may properly be discharged if following the 12 weeks of leave he/she is unable to perform one or more essential functions of the job.

The federal Americans with Disabilities Act (ADA) may trigger in her to require a reasonable accommodation. Light duty, if accepted by the employee, counts toward the 12 weeks, but must be explained up fronton.


Chirikos (1989) estimated total aggregate economic disability losses at $176.8 billion for year 1980.

Among orthopedic problems chronic low back pain is the one which results in the most disability.

Occupational lung disease is another burden on the compensation system.

One of the illnesses which qualify for disability benefits under the Social Security Law is mental illness which results from a "marked restriction of activities and interest, deteriorating personal habits, and a seriously impaired ability to get along with other people."

The eligibility for disability benefits for mental illness has also varied over time.

Reduction of the costs of disability is by reducing the incidence and prevalence of   disability.

Many physicians often do not understand the issues involved in the practice of Disability Medicine. This mainly is due to lack of experience or education in this field. Medical schools and residency trainings most often do not prepare physicians for this aspect of medical practice.