The News You Need for July 24
A case manager's guide to workers' compensation insurance and going deep on terminology in Kentucky.
Workers’ Compensation: The Premier Insurance for People
Case Management Focus
Sarasota, Fl (WorkersCompensation.com ) -- In this post, I will share why I think Workers' Compensation Insurance is the Premier Insurance for people.??
When I started working in workers' Compensation a fellow nurse case manager said, 'You either love workers' Compensation or you hate it. There is no in-between. ' As a nurse case manager who has worked in catastrophic case management, both in workers' Compensation and Group Health, I must agree.?
?For the injured worker, workers' compensation benefits are excellent—no co-pays, no deductibles, and mostly everything a doctor recommends is paid for by the insurance company if it is related to the work injury. One doctor said at a conference that workers' Compensation is the 'premier insurance' because it provides a more inclusive policy with little cost to the person compared to medical insurance.???
On the other hand, employers offer commercial healthcare insurance, or an individual can pay for a policy called Individual Health Insurance. Both have associated costs such as deductibles, co-pays, and out-of-pocket costs. Individual Health Insurance is complex to understand, especially if you are sick, you can’t work resulting in the loss of your employers insurance.?
If an employer provides health insurance for their employees, they usually works with a broker who shop for the lowest costs policy.? These policies usually have restrictions that limit care options and have high deductibles. Those who choose individual policies can select from an array of policies. A separate policy is more expensive and comes with costs that raise the price for the individual. It is a no-win situation.??
A workers' compensation policy is paid for by the employer at no cost to the employee, while a group health policy is subsidized by the employer. An employee pays their portion of the policy but really has no say in the type of policy they get.??
So yes, WC insurance is the premier insurance for a people. The best benefit of a workers' compensation policy is that a nurse case manager can assist with care coordination, transition of care, and breaking down barriers that impede the patient's care. On the other hand, commercial policies make it hard to find a case manager as they tend to be hidden from policyholders.??
?As I have often said, if you have to get injured or become ill, do it at work so you are covered under your worker’s comp policy.??
I write this post to help readers to become aware of the importance of advocating for affordable healthcare. The Affordable Healthcare Act passed in 2010 was a start, but we have a long way to go till commercial healthcare policies measure up to a worker's compensation health insurance policy. Case Managers who do both know this and should be advocating on the State and Federal Levels to find ways to ensure everyone is covered under a comprehensive healthcare policy…..that will help them with reasonable care and reduce sick care and the associated costs!??
领英推荐
What Do ‘Injury’ and ‘Occupational Disease’ Mean in Kentucky?
Glossary Check
Elizabethtown, KY (WorkersCompensation.com ) -- Let's say you find yourself in the Bluegrass State and someone needs to know, for workers' compensation purposes, what an injury is and what an occupational disease is.
If you had a Simply Research subscription, you'd have definitions from every U.S. jurisdiction at your fingertips, but in case you haven't signed up yet, you can tell them:
Injury. Any work-related traumatic event or series of traumatic events, including cumulative trauma, arising out of and in the course of employment that is the proximate cause producing a harmful change in the human organism evidenced by objective medical findings.
"Injury" does not include the effects of the natural aging process, and does not include any communicable disease unless the risk of contracting the disease is increased by the nature of the employment.
"Injury," when used generally, includes an occupational disease and damage to a prosthetic appliance, but it does not include a psychological, psychiatric, or stress-related change in the human organism, unless it is a direct result of a physical injury.
Occupational disease. A disease arising out of and in the course of employment.
An occupational disease is deemed to arise out of the employment if there is apparent to the rational mind, upon consideration of all the circumstances, a causal connection between the conditions under which the work is performed and the occupational disease, and which can be seen to have followed as a natural incident to the work as a result of the exposure occasioned by the nature of the employment and that can be fairly traced to the employment as the proximate cause.
The occupational disease must be incidental to the character of the business and not independent of the relationship of the employer and employee. An occupational disease doesn't need to have been foreseen or expected, but after its contraction, it must appear to be related to a risk connected with the employment and to have flowed from that source as a rational consequence.
Injurious Exposure. An exposure to an occupational hazard that would independently of any other cause whatsoever, produce or cause the disease for which the claim is made.