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Help Me, Help You - Leveraging Insurer Expertise To Control And Manage Workers Compensation Costs; A Winning Solution
Kate A. Wilkinson, Senior Director & Assistant Counsel, The Standard
Worker’s compensation programs generally pay benefits to employees who are injured or become sick as a result of working. Workers compensation pays lost wages, usually limited to a maximum of two thirds of an employees’ salary, and medical expenses. Depending on state law, it may be illegal for employers to retaliate or discriminate due to a workers’ use of compensation benefits. Short-term disability insurance (STD), offered by private insurers through employers, pays benefits to individuals who cannot work for temporary periods of time. Generally, STD policies specifically exclude work-related injuries or illness. STD policies, for example, usually specify that “work-related” injuries or illness are not covered. Those policies include coverage, generally, for car accidents, sickness, disease, pregnancy etc.
When selecting between fully insured STD products and advice to pay service/administrative services only options, employers should consider the ability of insurers to provide workers compensation guidance. With ATP/ASO services, insurers can provide behavioral health insights and suggest solutions. With ASO (administrative services only), the insurer reviews claims and pays benefits to the employees but is reimbursed by the employer. ATP (or advice to pay) programs are essentially self-funded plans where the insurer advises the employer on claims payment only.
As states continue to pass new paid family medical leave laws and enact programs, employers also need to consider the interaction of these new programs with existing workers compensation programs
In those cases, the insurer can help bridge the gaps between employer and the injured worker. Many insurers offer programs that focus on rehabilitation and returning workers to work as quickly as possible. Such programs aim for a proactive approach – consulting on disability issues and providing services such as ergonomic evaluations, identifying alternative jobs and assessing and suggesting resources for mental health conditions. These programs can work in conjunction with existing employer return to work programs or; where employers do not offer such programs, provide those types of services as part of disability insurance services.
For companies with high incidences of workers compensation injuries, looking to disability insurers for solutions makes sense. Insurers can provide insight and analysis in a proactive manner to help prevent those injuries.
Insurers can also provably an important role in managing and evaluating stress and mental health claims. Many states do not allow these types of claims for workers compensation at all.
As states continue to pass new paid family medical leave laws and enact programs, employers also need to consider the interaction of these new programs with existing workers compensation programs. In Washington for example, an injured workers can receive paid family medical benefits in addition to leave while receiving workers compensation benefits. These new state programs need to be carefully reviewed to understand the interplay with that state’s specific workers compensation programs.
In conclusion, the interplay between short term disability and worker’s compensation programs is tricky. Employers are well served to partner with a disability insurance provider to:
Provide advice and resources for preventing work-based injuries; and
Assist employees to return to work as soon as possible.