A generally agreed-upon definition of 24-hour coverage is any combination of traditional health and workers compensation insurance which together strives to eliminate the boundaries between occupational and nonoccupational coverage.
There are several perceived advantages to developing such programs. The most obvious may be additional cost control realized through administrative economies of scale and efficiencies resulting from improved integration of systems for providing health care services. These efficiencies may help to eliminate gaps and duplications of coverage.
There are two primary legal barriers complicating the development of 24-hour coverage programs. The first concern relates to the need to preserve the exclusive remedy doctrine that is fundamental to all workers compensation statutes. Conflicts and coordination of coverages under ERISA pose another hurdle. As 24-hour plans are based on providing several types of coverage, the concern has been raised that such plans would fall under Federal control through ERISA, and those benefits, policyholder protections and injured worker dispute remedies may be significantly different from existing individual state workers compensation programs.
Several states have workers compensation statutes allowing the use of alternative products or programs. However, those alternatives do not necessarily include 24-hour coverage programs.
Interest in 24-hour coverage programs has gained momentum over the past few years, in part, in response to the rising medical costs within the workers compensation systems. However, this interest has waned somewhat among employers as a result of improved market conditions.
Integrated Disability Management
Integrated disability management (IDM) is a new term for 24-hour coverage. It includes:
Historically, injuries and illnesses that occurred apart from work were treated by employers differently from those related to on-the-job activities. Today, some employers are treating all injuries and illnesses in a similar manner with the goal to get workers healthy as quick as possible and back on the job, even using light duty or modified duty jobs to accomplish the goal.
The most common step in integrating programs is that employers appoint one internal manager for all programs. The next step is to have a single claims payer. The last and most difficult step is to insure all programs under one insurance product. This step is difficult because workers compensation policies are highly regulated by state laws which may not permit blending of other coverages with workers comp on one policy.