Workers’ compensation

Compensation for bodily injury began shortly after the advent of written history. The ancient Sumerian Nippur Tablet No. 3191 (dating back to 2050 BC) outlines the king’s law that provides monetary compensation for specific injury to workers’ body parts, including fractures.* There are references in ancient Greek, Roman, Arab, and Chinese law providing for precise payments according to compensation schedules for the loss of a body part.* It was not until the 20th century that the U.S. began examining worker safety and, later, compensation for on-the-job injuries. The novel The Jungle by Upton Sinclair describes the horrendous working conditions in Chicago, IL, slaughterhouses in the early 1900s, which resulted in a public outcry on working conditions. The publication of this novel, in turn, led to the U.S. Food and Drug Act of 1906 and the Meat Inspection Act of 1906. President Howard Taft put into law the first compensation system to cover workers involved in interstate trade in 1908.*

Because labor regulation in the U.S. was set at the state level, it was up to state-level policymakers to pass their own legislation. Wisconsin was the first state to pass a comprehensive workers’ compensation law in 1911. By the end of that decade, 45 states had passed similar legislation. The last state to pass workers’ compensation legislation was Mississippi in 1948.*

As time passed, the American workforce continued to grow. In 2010, according to the Bureau of Labor Statistics Current Population Survey, the U.S. private and public workforce was composed of an estimated 139 million civilian workers. Every day many of these workers suffered injury, disability, and death from workplace incidents. In 2010, approximately 3.9 million workers in state and local government and private industry experienced a nonfatal injury or illness. That same year, more than 4,500 U.S. workers died from occupational injuries, another 2.6 million were treated in emergency rooms, and 110,000 of these workers were hospitalized. This loss of productivity comes with a huge price tag. In 2009, employers spent $74 billion on workers’ compensation insurance alone.

To examine the occurrence of occupational injuries in the National Trauma Data Bank® (NTDB®) research dataset for 2012, admissions medical records were searched using the field work-related (indication of whether the injury occurred during paid employment) with a field value of yes. A total of 31,713 records were found; 27,342 records contained a hospital discharge status, including 23,197 patients discharged to home, 2,403 to acute care/rehab, and 1,314 sent to skilled nursing facilities; 428 died. These patients were 88.8 percent male, on average 42.5 years of age, had an average hospital length of stay of 5.1 days, an intensive care unit length of stay of 5.7 days, an average injury severity score of nine, and were on the ventilator for an average of 6.9 days.

The number of incidents by occupational industry (based on U.S. Bureau of Labor Statistics Industry Classification) associated with the patient’s work environment can be seen in the figure. Of the 10,860 tested for alcohol, almost 10 percent were positive.

Figure 1. Number of incidents by occupational industry

Workers’ compensation legislation offers three critical benefits: (1) the employer gets tort relief for injury occurring in the workplace; (2) the employee gets a relatively quick and predictable no-fault compensation based on a published scheme; and (3) the system carries an inherent incentive toward rehabilitation of the injured worker. Even though these three benefits exist, adherence to on-the-job safety procedures and workplace-injury prevention are far better than any workers’ compensation.

Throughout the year, we will be highlighting data through brief reports in the Bulletin. The NTDB Annual Report 2012 is available on the ACS website as a PDF file and as a PowerPoint presentation at In addition, information regarding how to obtain NTDB data for more detailed study is available on the website. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at


Statistical support for this article has been provided by Chrystal Caden-Price, data analyst, NTDB.

*Guyton GP. A brief history of workers’ compensation. Iowa Orthop J. 1999;19:106-110. Available at: Accessed April 16, 2013.
Centers for Disease Control and Prevention. Workplace Safety and Health Topics. Traumatic occupational injuries. Available at: Accessed April 16, 2013.

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