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Health and Workers Comp Insurance Combination Possible Now


Health and Workers Comp Insurance Ripe for Combination

After finishing up the recent article on indemnity-only claims, one of the questions that I have had for years is “when will health and workers comp insurance combine into one line?”

pic of combo meal workers comp and health insurance
(c) Public Use License – dankeck

This question was covered a few times in prior articles such as 24 hour coverage and the ease that the Affordable Care Act would have had in adding the two coverages together.

Just before the pandemic, this article covered how the combo idea was in the rearview mirror.

Now, after the indemnity-only article linked to earlier, 24 hour coverage may be again up for debate.   The passage from the combined workers comp rating bureaus’ study on the effect of the pandemic that made me write this article was:

A typically small claim, representing a few weeks of indemnity payments. Examples include mild cases where a positive COVID-19 test was not reimbursed through WC, quarantine claims (where covered), and/or claims where the medical was paid by another payer.

NCCI presented at AIS 2022 that indemnity-only claims accounted for almost 50% of the COVID-19 claims.

Past Attempts at Combination

Carve outs were an attempt to combine health and workers comp insurance.  The AFLAC model is an example of where health and indemnity benefits are paid simultaneously.

The last big initiative to for 24 hour coverage was Colorado’s Amendment 69 which was overwhelmingly voted against in 2016. The amendment would have created ColoradoCare.  Coloradans voted almost 3 to 1 against establishing this program. (Wow)

Now, with the added impetus of workers comp claims partially being pad outside the system, should the discussion start again as to why or why not health and workers comp insurance  should be combined into a monoline?

Bottom Line – Future Health and Workers Comp Insurance Changes

As I have advised many times in past articles, anyone attached to the workers comp industry should be ready for changes.   One only has to point out how many insurance industry workers now work entirely from home?  Could you have seen that twenty years ago? (No)

I am a huge advocate for “outside the box” training such as subrogation and now probably health insurance.  Workers comp personnel may have to become more specialized in health insurance would be my crystal ball projection.

If you are an agent, adjuster, or anyone that requires a license to handle property and casualty insurance, health and workers comp insurance requires two different licenses – one wonders why.



James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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