Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2014-110, 2014 Jan; :1-42
The purpose of this document is to help public health researchers and practitioners, particularly those in occupational safety and health, to broaden their understanding of workers' compensation insurance, relevant aspects of the insurance industry records, and the potential uses of that information for public health purposes. Workers' compensation insurance has been established in all states to provide income protection, medical treatment, and rehabilitation for employees who are injured or become ill as a result of work. Workers' compensation claims and medical treatment records along with other information resources have been used to conduct occupational safety and health research and surveillance and to identify intervention needs. Several government agencies and private organizations sponsored two workshops in September 2009 and June 2012 on the use of workers' compensation data for occupational safety and health purposes. The workshops featured discussions of opportunities for collaboration in the analysis of workers' compensation data in order to help reduce the risks of occupational injuries and illnesses. Participants included representatives from private insurance carriers, insurance associations, self-insured corporations, academic institutions and government agencies. Presentations in the first workshop described differences among state laws, proper interpretation of common industry terms, proprietary interests in insurance data, public release of internal analyses, methods for linking workers' compensation records with other health and employment records, and independent analysis of claims data by health scientists, economists and government agencies [NIOSH 2010; Utterback et al. 2012]. One of the principal messages from the first workshop was that even though workers' compensation records are primarily designed and used by the insurance industry to administer claims, public health investigators are interested in them for prevention and control of occupational injuries and illnesses. The interested parties have different perspectives on the value and potential uses of workers' compensation data. Relationships would need to build trust and respect for the various stakeholder perspectives to foster collaboration. The second workshop included discussions of six draft white papers along with 35 platform and poster presentations on research with workers' compensation data [NIOSH 2013a]. Although much progress is being made in understanding the merits of workers' compensation data resources, significant limitations exist. For example, these data appear to constitute an incomplete record of occupational injuries and illnesses at the state level. While standards for collecting and compiling the data exist, they are not universally used. Some fields on the record forms are often blank or incomplete and essential information for public health purposes, such as occupation, race, ethnicity, and duration of employment, may not be recorded. Multiple parties add data to the records at various stages as claims work their ways through the employees, employers, medical facilities, third-party administrators and state agencies. Nonetheless, important public health research can be conducted with available data as long as the limitations and their effects on generalizability are considered. At the end of the second workshop, some commented that the public health and the insurance communities may have different interpretations of terms in common usage and overcoming that barrier might be facilitated by a summary of the workers' compensation industry and a crosswalk of terminology used by each group. A team began work on this document as a result. Following the background and brief history of the workers' compensation programs in the U.S., this primer describes: (1) benefits and premiums; (2) the relationship between premiums and safety incentives; (3) roles of insurers, state agencies and third party administrators; (4) types of policies; (5) claims and other workers' compensation insurance information on medical treatments, costs and disability status; (6) limitations of current industry data standards; (7) loss prevention programs; and (8) public health research, surveillance and regulations.