How does worker's compensation and other forms of liability insurance work in a single-payer system?

Factual Questions
1

I was recently injured at work and I am working on getting treatment for my injury using my employer’s worker’s comp coverage. That got my wondering, what would this be like if the US had a single-payer healthcare system? Would my employer (or their insurance company, as in my case) get stuck with the bill or would I simply see my doctor like always and Uncle Sam would take care of paying? What about liability coverage, such as if someone slips and falls at the grocery store or is injured by a falling tree limb at my house? Or, what about the medical bills that can occur after a car accident?

So, how do medical bills get paid under a single-payer system when the illness or injury is due to someone else’s liability rather than a simple “act of God” sort of thing?

2

Canadians are covered by workers compensation insurance paid for by employers.

3

In Norway at least the medical costs are just treated as any other.

If someone is found to be at fault due to illegal action or failure to act according to laws and regulations, their insurance company, or themselves, might be on the hook for further awards to the injured, but not for the basic medical costs.

4

Likewise in the UK. The NHS might claim against employer’s liability insurance if there’s negligence involved, and they do recover a set rate for traffic accidents from the liable driver’s insurance company.

But it would be up to your Congress to set the rules for your putative single payer (more likely, “regulated payers”).

5

How it works is, almost always when you present for treatment, at Drs office or emerg, you will be asked directly if you did this injury at work.

If yes, they will them confirm that you HAVE reported it to your employer. If you haven’t, they will insist you do so. If you have already you’re good.

You then get whatever care you require and … that’s it. Who pays, your provincial health insurance plan or your employers workers comp insurance, is sorted out by the hospital/Dr’s office.

Just that simple. Of course workers comp claims can be complicated, disputed, refused. Should that happen, you won’t get compensation for your time off work, etc, very likely. But your medical care will still get paid by your single payer gov plan.

6

What Leaffan and elbows said, for Canada. You get hurt, you go to hospital, they provide medical care. It’s that simple.

There may be payments behind the scenes between Workers’ Comp and the provincial medicare plan, but you as a patient don’t need to worry about that.

Bear in mind, our Workers’ Comp system is different from yours. I gather in the States, employers get workers’ comp insurance from private insurance companies? So if there’s a workplace injury the insurance company pays the medical costs billed by the doctor/hospital etc., and the employer’s premiums may go up as a result?

That’s not how it works in Canada. Here, as Leaffan mentions, employers pay an amount for each employee. That levy goes into a fund maintained by the Province for the entire workforce (there are some types of occupations that are exempt, but they’re relatively small in number). The Workers’ Compensation Agency is set up under provincial law, and it administers the funds.

Since medical coverage is already there under medicare, the main thrust of Workers’ Comp is income replacement (paying the injured worker the salary equivalent for lost work) and occupational therapy programs that go beyond what medicare provides, to help get the worker back to work.

Same for car accidents and tree branches falling down: if you get hurt, you go to hospital and get medical care. Insurers may dicker behind the scenes, but you as the individual don’t usually get involved in that, since you’re not out of pocket for medical care. Where you get involved in insurance claims is if you’ve been injured and are claiming for lost wages, permanent impairments, loss of enjoyment of life, etc.

7

Just noticed this part of the OP and realized I didn’t respond to it.

We don’t have medical bills in Canada. I’ve never got one for any of the times I or my family has got medical care. You go to the doctor’s office or hospital, present your provincial health card, and get health care.

8

Spain’s system is actually divided in two, with general illnesses going directly to SS but “workers healthcare companies” being involved in work-related preventative care, work accidents and work-caused illnesses. The funds eventually come from the same pouch.

Let’s say you break a leg while on vacation, and to keep it simpler let’s say you hadn’t traveled. You go to the local ER, get some X-rays and a cast, and handed a baja (medical leave, medical rest order). The baja also says when are you expected to be able to go back to work, when can you expect your alta. Your baja needs to make its way to HR. Eventually you get the alta, hand it at work and rejoin. This has all involved exclusively doctors from medical centers that are part of the general, non-work-related network. No bills issued.
Now let’s say you slip at work and break a leg. You’re taken to the ER, where they give you X-rays and a cast and a baja. Since the injury took place at work, the baja needs to also be handed over to the mutua, the workers’ care company chosen by your employer; this company may contest it but in general they’re unlikely to do so (normally they’ll just want copies of all the tests taken by the regular docs, at this point). If your baja goes on for too long, they may ask to run their own tests to make sure you’re not exploiting the system; once you get the medical alta from the regular docs the docs in the mutua will have to issue their own alta, which is the one that’s valid for your employer (this second alta is supposed to take specific information about your job into account - requirements for an office worker and a truck driver aren’t the same). No bills issued.
The payment for both situations comes from the Social Security tax, which also covers unemployment benefits (they’re not linked to your last employer at all) and many other parts of the social safety network. Decent companies normally have additional insurance for catastrophic cases such as death on the job or permanent disability caused by a work-related injury or illness: if you’re disabled on the job you’ll go on disability (and that also comes from SS), but the additional insurance means an additional payout which for good insurance companies may actually be paid before SS gets around to processing your case.

9

When I was injured at work, I was taken to hospital and treated on the NHS. As is their legal duty, my employer reported the accident and it was investigated. Ther were found to be negligent, but not fined; just advised to put some procedures in place.

A found a solicitor and started proceedings for compensation. Their insurers sent me to a consultant for a prognosis, and after some wrangling I was duly compensated for pain & injury and for other expenses. They also paid my lost wages in full. I was off for six months.

The basic compo payment was tax free, but the wages part was taxed as income.

The NHS (ie the taxpayer) covered most medical bills; The employer’s insurance paid the rest. They also paid for some physio and the consultants consultation.

10

Case for Germany (not single payer but mandatory insurance by statutory carriers, with an opt-out into private insurance for some groups of people)

If I present at a doctor, or am served by an emergency doctor or ambulance crew, there is a check box for “work/way to work injury” on the intake paperwork/datawork. If that is checked

(a) care is billed not to my regular statutory health insurance (Krankenkasse) but to the separate statutory workers’ comp insurance body (Berufsgenossenschaft). This insurance body is determined by my employer’s industry so they want to know who my employer is too.

(b) some more expensive treatments are authorized (e.g. my SO got expensive artificial skin when she scalded her leg pouring coffee at work (the coffee was for the disabled residents so pouring it was work). The doctors said she’d have got less expensive treatment if she’d incurred it at home)

© further rehabilitative care is mandatory and done by specialized, Berufsgenossenschaft affiliated doctors.

(d) Inpatient rehab at rehabilitation clinics, as well as disability benefits for any remaining disability, is more generous that for injuries/disabilities incurred in private life.

One important aspect of the German workers’ compensation scheme is that the number of commuting accidents covered is larger than the number of work accidents covered. Workers’ compensation covers you from leaving your house for work until entering your house back (except for private activities during breaks).

As the disability and rehabilitation benefits under workers’ comp are more generous than medical insurance rehab/pension insurance disability people are very keen to have their injury classed as part of their commute. There are verdicts of the social insurance courts on edge cases in the news from time to time (e.g. if you take a large meal in a restaurant on your way home this is considered the end of your commute and you are not covered in the restaurant and the rest of the way home. If on the other hand you just grab a sausage at a stall because you are tired from work and need something in your stomach, this may not count as the end of your commute and you may be covered if you slip and fall at the sausage stand.)

11

When I slipped on ice and broke my ankle just about a dozen years ago, I went to the hospital where I spent 6 days (it took 4 days for the swelling to go down so they could operate) had an operation and then walked (or hobbled, to be sure) out of the hospital and went home. Several months later, the health board sent me a questionaire basically inquiring whether they could collect from anyone for negligence. It was, in fact, negligence of the city of Montreal who had closed the sidewalk for construction and not provided any way around except on an icy park. That was the last I heard of it. But there were never any bills. It is the job of the hospital, of the surgeon, of the anesthetist, of the nurses, and they did it.

But I can imagine that it might have been handled differently in other countries.

When my youngest son was born in 1973 I paid an extra $7 a night for a private room.

12

When I was riding my motorcycle home from work and got hit by a car at an intersection, the ambulance, the hospital treatment (surgery to insert pins in broken wrist, 3 nights stay), physiotherapy and 80% of my normal wage for the three weeks I was off work were all paid for by ACC (Accident Compensation Corporation), the government run personal injury insurer. My employer paid the balance of my wage and took 1 day sick leave for every 5 days I was off work. (The 20% not paid by ACC.)

Because it was deemed an accident at or travelling to or from work, my employer’s levy would be used for payment. At the time, some employers such as mine were so-called self insured, so any payments would come directly from them rather than the general risk pool.

ACC is a no fault system, so there is no deciding who is to blame and who should pay. Legislation associated with the scheme prevents victims from suing to recover compensation when the injury is covered by ACC.

The devil can be in the detail though. Sometimes ACC decide that not all the damage is due to the accidental injury, and may be wear and tear (age related arthritis, say). It is possible to appeal against such judgements, but it seems ACC will always believe their own medical consultants rather than yours, even if their consultant has never even seen you, but is just relying on medical notes.

I pay an earner’s levy at 1.39% up to $124,053 p.a so a maximum of $1724.33 for this year. This is to cover non-work related injuries and rehabilitation. There are also levies on motor vehicle registration, and as part of fuel taxes.
Conversely, when my husband was admitted to hospital severely dehydrated after 4 days of almost continuous vomiting, I paid the ambulance part charge ($80) but nothing else. The general health payments system allocated to our district health board paid for his treatment and stay for 4 nights. Also EKG and all lab tests of blood, vomit and other. We paid $5 each for prescription drugs once he was discharged.

District health boards (DHBs) are responsible for providing or funding the provision of health services in their district. Disability support services and some health services are funded and purchased nationally by the Ministry of Health. Public hospitals are owned and funded by DHBs. All DHBs are funded by general taxation through a government grant.

Government funding of health and disability services means that eligible people may receive free inpatient and outpatient public hospital services, subsidies on prescription items and a range of support services for people with disabilities in the community.

13

You’re posting from New Zealand? The “Kiwi Fruit” makes me think so, but thought I’d ask.

14

Thanks for the responses. Here is what I have learned:

  1. In single-payer countries, the most important thing is getting care. No matter how you’ve been injured, you present yourself to the doctor/hospital/provider and you get the treatment you need.
  2. The financial end of things is handled behind the scenes. The patient’s role is only to provide factual information about how the injury occurred.
  3. In many places, employers pay a tax to cover workers’ comp coverage. In others, employers buy their own insurance from private providers. Either way, the doctor/hospital handles the billing and collecting, not the patient.
  4. Germany sounds really awesome, covering workers from door to door. I can see how that really gets complicated, though. I don’t see how it’s fair to hold an employer responsible for a car crash that happens outside of his control. Plus, suppose a worker leaves work to head for home. On his way, he plans to stop at a store and pick up some groceries. Does his commute stop at the grocery store? What happens if he crashes before arriving at the store? Or crashes after the store? What if the worker takes a scenic route home instead of a direct route? Or, he departs from his normal commuting routine and ends up in a crash?

I’m still a bit confused about personal injury liability. Kiwi Fruit described a motor vehicle accident. I sort of understand no-fault insurance, but it still seems…weird to me. If a driver simply runs a stop sign and smashes into you, he suffers no financial consequences? Do people simply drive with reckless abandon, secure in the knowledge that they won’t have to pay for anything they may break?

Hari Seldon talked about a slip-and-fall accident in Montreal. In the United States, this would have been a challenge to pursue if the fault, in fact, lied with the city government. Governments have sovereign immunity in most cases. It’s really tough to fight city hall.

Thank y’all for helping me to understand. Sounds like single-payer is still the best way to go, even when it’s a workplace or liability injury.

15

In-transit is covered in other UHC systems as well; Spain and France are the ones I know best. For Spain, that dude who stops at the grocery store would be covered if it’s a routine thing and doesn’t require going out of the way; he wouldn’t be covered if, instead of stopping at the supermarket which only takes him a few hundred meters out of the way (as he does at least once a week), he’d driven a long way out of his usual drive to go to the nearest IKEA (which is 90km out of the way). He would also not be covered while in the store (the shopping itself isn’t part of the commute and the supermarket has its own third-party insurance).

Note that he’d still do the same stuff doctor-wise, just with a question of whether the mutua needs to get involved or not. Medically he’d be covered in any case, what’s different is who would be handling payments and some paperwork which is mostly invisible to the worker.

16

In France, the rule is that you pay for your healthcare, and you’re reimbursed later. There are so many exceptions that in fact you rarely do (your GP bills directly the healthcare system, so does your pharmacist, etc…and most often you’re only left with the co-pay) , but it’s still the general principle.

Also, MDs can charge more than what is reimbursed by the healthcare system. A lot of people have complementary insurances that cover partly or fully this overcharge, but not everybody does. So, again, you might have out of pocket expenses. And you’re going to be billed a fixed daily payment if you stay at the hospital, and so on…
So, in the case of of an accident occuring at work (or while your going to or back from work, since as already mentioned, in France too an accident occuring during your commute is considered a work-related injury), there’s in fact a difference : you don’t pay anything, and whatever bill you might have incured is sent to your employer.

However, the main reason why it’s important to have your accident considered as work-related is for worker compensation while you’re on medical leave and protection against dismissal. For the record, yes, you’re covered too for usual everyday life activities that you’re expected to do on your way to work, like stopping for groceries or dropping your children at school. But indeed, deciding whether or not an accident during your commute is work-related can lead to litigation.
I’m not sure how it works when a third party other than you employer is liable for an accident you’re victim of. I think you pay normally your medical expenses and the insurance company reimburses you later as part of the damages you’re entitled to, but I’m not absolutely sure.

17

This probably varies even more tremendously.
In the state of Victoria, Australia, basic vehicle liability is a part of the cost of vehicle registration. This makes registering a vehicle more expensive, but there’s no need to buy private insurance to drive.
For example, my wife’s MX-5 (a Miata) costs 675AUD to register per year. 265AUD of that is the registration fee, while the rest is what’s called the TAC charge. TAC stands for Transport Accident Commission.
When you think about it, it makes a fair amount of sense. If you have to have something to legally drive, it may as well be part of the registration.
Now, why aren’t people Mad Maxing into each other at all hours? Accidents hurt!

18

In addition to what naita said about Norway:

You don’t get billed for medically necessary healthcare, except co-pays. Which are capped at about 300 $ per year, total. In general, the extra administration involved in setting up separate systems for billing would cost more than you’d get in revenue.

Workmens comp, as in mandated employer insurance, deals with issues such as permanently reduced ability to work due to injuries, etc.

I’ve often found Americans wonder about were all the bills go in single payer systems, and finding their absence either suspicious or miraculous. After thinking about it, I think the best analogy is to say that we provide healthcare much like we both provide basic education.

19

Of course he suffers financial consequences. If he’s sufficiently negligent* the insurance company may seek to be reimbursed for their payout to the injured party, and may refuse to pay out his collision insurance, if he has collision, which unlike liability is not compulsory.
Even if not grossly negligent, being at fault in an accident will (in Norway) reduce insurance rebates you’ve earned by “claim free driving”. (I’m currently at 75 % premium reduction, having never filed a claim.)
And if grossly negligent you will be prosecuted for reckless driving.

The idea that medical costs specifically should be a part of the punishment for a reckless driver only makes sense if that’s the system one is used to, and to someone not used to it seems to add further to the randomness of the cost of accidents.

*In Norway for liability insurance on motor vehicles, the insurance company must always absorb the cost, even in cases of gross negligence, except for accidents caused by drug and alcohol use.

20

In vic.aus (and very simlar in other states), the “single pay insurere” run by the government covers the most important health and sickness stuff, but still leaves a lot of edge cases, and actually, a lot of the centre as well.

Hospitals start with 4 important billing regimes: (1) Government (State and Federal), (2) Transport Accident, (3) Workplace Accident, (4) Private Insurance. If you look around, you can actually find published the rates the public hospitals charge these different insurers.

As it happens, vic TAC (Transport Accdent Commision) pays higher rates than the Government does, so hospitals are pretty generous to TAC funded patients: they won’t make you go home and wait for treatment, and they don’t kick you out at the first chance.