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Barriers to use of workers' compensation insurance for patient care: the experience in community health centers.

Massachusetts Department of Public Health
Boston, MA: Massachusetts Department of Public Health, 2011 Apr; :1-8
Community health centers (CHCs) work in partnership with the Massachusetts Department of Public Health (MDPH) to provide high quality health care for Massachusetts residents, especially the underserved. One key resource for patients is workers' compensation insurance, which is designed to cover health care costs for work-related illnesses and injuries, as well as partial wage replacement when such conditions cause people to miss work. CHCs and other health care providers play a crucial role in helping patients use workers' compensation (WC). A provider's assessment that work is a major (but not necessarily predominant) cause of disability or need for treatment is often the key to qualifying the patient for benefits.(1) Providers and staff can also educate patients about obtaining WC benefits. Patient access to WC benefits is also important for public health. WC claims are a major source of data that helps the MDPH Occupational Health Surveillance Program (OHSP) identify hazardous industries, exposures, and workplaces and then target efforts to improve workplace safety and health. There is increasing evidence that many workers eligible for WC do not to receive it, either because they don't apply or are denied coverage. In Massachusetts, a 2007 survey of more than 4,000 adults found that 4.2% reported being injured seriously enough while on the job during the previous 12 months that they required medical advice or treatment, but of these, less than 60% reported that WC paid for the care. Some were even unable to obtain treatment. Findings were similar in other states.(2) These results raise concern about access to WC benefits for workers treated in CHCs as well as other health care settings. It is widely recognized that low income workers, including many immigrant and minority workers, the populations often served by CHCs, are disportionately employed in dangerous jobs.(3) Over the last several years, OHSP has worked with a number of CHCs to improve their capacity to identify and address occupational health needs of their patients. These CHCs have alerted OHSP to a number of barriers they face in using WC. If such barriers are widespread, they may present problems both for patients' access to benefits and for occupational health data collection. Underutilization of WC benefits can also shift costs to other forms of insurance or publically supported care. In 2008-2009, OHSP surveyed administrators and medical directors at 76 CHCs across the state to learn more about the barriers they face in using WC. This report presents the results of that survey based on responses by 56 CHCs. It includes recommendations to improve CHCs' ability to secure WC benefits for their patients when appropriate.
Public-health; Occupational-health; Health-care; Health-care-facilities; Health-programs; Health-services; Medical-care; Worker-health; Disabled-workers; Surveillance-programs; Lost-work-days; Sociological-factors; Education; Injuries; Health-surveys; Health-care-personnel; Administration; Information-systems; Work-organization; Statistical-analysis; Physical-therapy
Massachusetts Department of Public Health, Occupational Health Surveillance Program, 250 Washington Street, 6th Floor, Boston, MA 02108
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Barriers to use of workers' compensation insurance for patient care: the experience in community health centers
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Massachusetts State Department of Public Health
Page last reviewed: March 25, 2022
Content source: National Institute for Occupational Safety and Health Education and Information Division