Protection Against Income Loss During the First 4 Months of Illness or Injury *

Transcription

1 Protection Against Income Loss During the First 4 Months of Iness or Injury * This note examines and describes the kinds of income protection that are avaiabe to workers during the first 6 months of iness or injury; it aso provides estimates of benefits paid and estimates of earnings ost due to ack of coverage. In 199 1, wage and saary workers and the sef-empoyed ost a tota of about $69.6 biion in earnings due to short-term iness or injury (tabe 1). Of this amount, about $46.5 biion--or two-thirds-was repaced through income protection payments to workers in pubic and private sector jobs. Overview The purpose of short-term disabiity protection is to assure a continuous income for workers who are unabe to work because of temporary iness or injury. Such short-term benefits are meant to repace ost earnings unti the person is abe to resume work. If the iness or injury requires a ong-term absence from work, the income serves as a bridge between empoyment and ong-term disabiity benefits. The waiting period for shortterm sickness insurance benefits (though not sick eave) is typicay 1 week, whereas the waiting period for ong-term disabiity benefits under Socia Security s Disabiity insurance (DI) program is 5 months. Maternity benefits are usuay incuded under temporary disabiity insurance pans. If a sickness or injury occurs outside the workpace and is not job-reated, it is referred to as a nonoccupationa iness. The three programs that protect workers against this kind of income oss are: * Wimer L. Kerns, Division of Program Anaysis, Office of Research and Statistics, Socia Security Administration. (1) temporary disabiity insurance (TDI) programs in certain States, (2) paid sick eave, and (3) empoyment-reated group insurance. Individua insurance can provide simiar protection, but it is purchased individuay from private insurance companies and is not an empoyment-reated program. Another cass of income protection is provided by workers compensation programs, which cover job-reated injuries or occupationa inesses. These statutory State programs are avaiabe in a States. In addition, Genera Assistance is avaiabe in some or a oca jurisdictions within 36 States, and serves as a safety net providing cash assistance to needy persons who do not quaify for federay funded assistance. Genera Assistance is fmanced entirey by States and/or oca governments. Tabe 2 provides a summary of benefits paid under the programs discussed in this note and additionay summarizes information contained in tabes 36. Tabe 2 aso incudes benefits received for the 6th month of disabiity under Socia Security Disabiity Insurance. Short-Term Income Protection for Nonoccupationa Iness The Socia Security Administration (SSA) has had a ong-standing interest in knowing the amount of income ost by workers who become sick or temporariy disabed. SSA deveoped and maintained a data series covering the period, which estimated and tracked income osses, as we as benefits that were paid out by income-repacement programs. This note extends the series, with certain modifications, taking advantage of data from three empoyee-benefit surveys that are now conducted annuay by the Bureau of Labor Statistics (BLS), Department of Labor.2 Temporary Disabiity Insurance TDI programs operate under statutory provisions in Caifornia, Hawaii, New Jersey, New York, Rhode Isand, and Puerto Rico. Aso, a rairoad workers are covered under the Rairoad Unempoyment Insurance Act. Most of the State programs were estabished during the 1940 s as an outgrowth of the unempoyment insurance (UI) program. Unike UI, which is a joint Federa-State program, TDI is excusivey a State program with no Federa egisation, except in the case of the rairoad industry. SSA coects annua informatio~r from each of the TDI jurisdictions and pubishes the resuts in Tabe 9.C in the Annua Statistica Suppement to the Socia Security Buetin. In 1991, about 2 I.3 miion workers, or 22 percent of the nationa private sector workforce, were covered by TDI (tabe 3). TDI programs are financed with specia funds. In Caifornia and Rhode Isand, workers contribute the entire amount required to finance these State programs. In New York, Hawaii, New Jersey, and Puerto Rico, the programs are fmanced jointy by empoyee and empoyer contributions. The Rairoad Retirement program is financed by a tax on empoyers. To quaify for benefits, workers generay must be unabe to perform their reguar or customary work because of a physica or menta condition. Caimants may be disquaified if they receive certain types of disabiityreated income, incuding workers compensation and unempoyment insurance, and, sometimes, sick eave and jobreated pensions. Caimants must aso have a specified amount of past empoyment or earnings to quaify for benefits. In 199 1, approximatey 320,000 persons received TDI benefits amounting to $3.7 biion, providing an average weeky benefit of about $182. The average dura- 88 Socia Security Buetin Vo. 57, No. 3 Fa 1994

2 tion of benefits was about 11 weeks, athough it varied from State to State. Benefits from pubicy operated funds in Caifornia, New Jersey, Rhode Isand, Puerto Rico, the New York State Insurance Fund (a competitive State carrier), specia funds for the disabed unempoyed in Hawaii and New York, and the rairoad program amounted to $2.8 biion or three-fourths of tota benefits paid in 1991 under the TDI programs. Programs funded by the private sector accounted for the other 25 percent ($0.9 biion) of tota benefits paid (tabe 3). aws and 11 percent have other group sickness insurance); 26 percent have sick eave ony; 20 percent have short-term disabiity insurance ony (10 percent are covered under TDI aws and 10 percent have other group sickness insurance); 30 percent have neither sick eave nor short-term disabiity insurance. In summary, 70 percent of the private sector workforce is covered by some kind of income protection, either sick eave or disabiity insurance, whie 30 percent acks protection.5 Aso, 44 percent of workers in the private sector are covered by some type of short-term disabiity insurance. As expected, sick eave is more prevaent for pubic sector jobs than for jobs in private industry. Fiftyseven percent of fu-time workers in the private sector are covered by sick eave, whie ony 17 percent of part-time workers in that sector are covered.6 Sick eave benefits are more generous in arge firms than in sma firms. Aso benefits are Paid Sick Leave Paid sick eave is a major source of protection against earnings oss due to short-term iness or injury. It is often a fu-repacement benefit that requires no unreimbursed waiting period. The aggregate vaue for this benefit is comparativey high, estimated to be $24.6 biion in Of this amount, sick eave for workers in private industry accounted for $12.1 biion, whie the consideraby smaer number of government empoyees received $12.5 biion in sick eave benefits. Tabe 4 shows the number of workers covered and benefits paid in 1991 in the private sector. Tabe 5 presents data on paid sick eave, by type of empoyment, from 1988 through The BLS surveys show that during , 56 percent of a workers in the United States had sick eave avaiabe to them. Of that percentage of a workers, 50 percent of a empoyees in the private sector had sick eave, compared with 90 percent of empoyees in the pubic sector.3 Within the private sector, about 62 percent of empoyees in medium and arge firms were covered by sick eave, and 40 percent in sma private estabishments. Aso within the private sector, paid sick eave is offered to 77 percent of professiona and technica empoyees, 59 percent of cerica and saes empoyees, and 33 percent of empoyees in production and service. Sick eave and reated coverage of workers in the private sector is as foows:4 24 percent have sick eave and short-term disabiity insurance (12 percent are insured under TDI Tabe 1.-Estimated tota income oss due to injury or iness, by type of empoyment, ~~~ I--- Type of empoyment * Wage and saary workers... +~... $60,187 $63,862 $67,740 $69,590 Private sector... 41,447 43,817 46,334 47,177 Covered by TDI ,605 12,269 12,974 13,210 Not covered by TDI ,842 31,548 33,360 33,967 Pubic empoyment ,171 11,941 12,929 13,630 Federa empoyees : 2,821 2,941 3,159 3,307 State and oca empoyees ,350 9,000 9,770 10,323 Sef-empoyed ,569 8,104 8,477 8,783 - Assumes 5.3 days of work-oss per empoyee per 255-day work year for persons who are currenty empoyed. Assumes an &day work-oss per empoyee in a 260-day work year. Assumes a 7-day work-oss per empoyee in a 255-day work year, with 90 percent coverage. 4Assumes a 7-day work-oss in a 300-day year. Tabe 2.-Benefits provided as protection against short-term income oss, Type of benefit i Tota benefits $37,218 $40,739 $43,426 $46,466 6th month of Socia Security DI benefits... I Individua insurance _... ~ 2,057 2,45 1 2,70 1 2,588 Empoyment-reated benefits..,... 34,898 38,007 40,388 43,500 Benefits to workers in private sector (nonoccupationa) ,332 16,840 17,315 17,585 Private cash-sickness insurance and sef-insurance funds ,903 2,732 2,711 2,645 Pubicy operated cash-sickness insurance (TDI)......_... 1,779 1,907 2,269 2,817 Sick eave... 10,651 12,201 12,336 12,123 Workers compensation...,..._... ~ 9,300 10,200 11,200 13,400 Government empoyee sick eave... 10,266 10,967 11,873 12,515 Genera Assistance L It is assumed that 53 percent of tota payments for workers compensation are for short-term iness or injury. Recent payment data are not avaiabe, but have been projected from pre-1981 data. About 15 percent of tota payments are attributed to short-term sickness. Socia Security Buetin Vo. 57, No. 3 Fa

3 more generous for empoyees who have the most ongevity, and are more frequenty associated with saaried or whitecoar workers. However, if a worker has a asting disabiity and quaifies for Socia Security DI benefits, even the most generous sick eave rarey provides a fu income throughout the minimum 5- month waiting period required by the DI program. The average annua work-oss per currenty empoyed worker in the private sector is about 5.3 days, according to the Nationa Heath Interview Survey (NHIS) conducted annuay by the Pubic Heath Service. This figure does not take into account persons in the first 6 months of a nonoccupationa iness or injury, who no onger report that they are currenty em- poyed. The NHIS defines the currenty empoyed popuation as persons who were working or had a job or business during the 2-week period preceding the week of interviewe7 Heath-reated workoss eves are probaby higher than the nationa househod surveys indicated. Surveys, such as NHIS, the Survey of Income and Program Participation (SIPP), and the Current Popuation Survey (CPS), do not determine the onset of disabiity and reate it to income and work-oss during the fust 6 months of iness or injury. When deriving these heath-reated work-oss estimates, it is assumed that workers in the private sector receive an average of 3 days of paid sick eave per year when they have no other protection Tabe 3.-Benefits provided under State temporary disabiity insurance programs. by funding mechanism, Funding mechanism sr,11990(1991 Tota... $2,601.4 $2,748.3 $3,154.4 $3,738.8 Private sector funding2..._ Group insurance Sef-insurance _... Pubicy operated funds ,:::I: 1,z2:: 2,::::: 2,::::: Programs under the aws of Caifornia, Hawaii, New Jersey, New York, Rhode Isand, Puerto Rico, and the Rairoad Unempoyment Insurance Act. Excudes hospita, surgica, and medica benefits in New York. Under the aws of Caifornia, Hawaii, New Jersey, New York, and Puerto Rico. 3Empoyers may sef-insure by observing certain stipuations of the aw. Aso, incudes some unionmanagement pans. 41ncudes State-operated funds in Caifornia, New Jersey, Rhode Isand, Puerto Rico, the New York State Insurance Fund (a competitive State carrier), and specia funds for the disabed unempoyed in Hawaii and New York, and the rairoad program. Tabe 4.-Sick eave coverage and benefits paid to workers in the private sector, Coverage Tota workers with sick eave coverage... With sick eave ony..... With sick eave and TDI coverage..... Sick eave and group sickness coverage..... Sick eave ~ Number of workers covered (in miions) $12, , , ,350 9 The purpose of this tabe is to iustrate how other income-protection programs overap with sick eave in the private sector. Estimated. I Percent covered and 2.4 days when they do have other (group) protection. These numbers are proportionatey consistent with those used in the previous data series. It is aso assumed that sef-empoyed persons ose 7 days of work per year due to iness or injury. Average annua paid sick eave for Federa empoyees amounts to about 8 days per empoyee, or 3 percent of payro8 Average annua consumption of sick eave by empoyees in State and oca governments is estimated to be about 7 days in a 2.55day work year, and sick eave covers ony 90 percent of the work-oss. Thus, sick eave benefits for empoyees in the pubic sector provide protection against neary a the average work-oss per year, whereas in the private sector ony about haf of the work-oss days are reimbursed for covered workers, and no sick eave benefits at a are avaiabe for the remaining 50 percent of empoyees. Aggregate sick eave benefit patterns are directy reated to empoyment eves. Group Insurance Group insurance is used in this note to refer to both empoyment-reated group sickness insurance and the reativey sma category of empoyers sef-funded sickness insurance. Tabe 6 shows benefit payments for group insurance in both TDI and non-tdi jurisdictions. Group insurance benefits in States with TDI programs amounted to $0.9 biion in During the same year, a tota of $1.7 biion was paid to beneficiaries under vountary, private-sector provisions, of which empoyment-reated group insurance accounted for $1,585.9 miion, and sef-funded insurance by empoyers amounted to $137.1 miion. The atter type of insurance incudes some unionmanagement pans. It shoud be noted that group insurance benefits under TDI provisions have steadiy increased, from $823 miion in 1988 to $922 miion in 1991, whie group benefits in vountary (non-tdi) programs have decreased from $1,962 miion in 1988 to $1,586 in Individua Insurance Insurance protection may aso be provided by poicies purchased privatey by 90 Socia Security Buetin Vo. 57, No. 3 Fa 1994

4 individuas. Individua insurance is the primary type of protection used by the sef-empoyed. This kind of protection is cassified as a form of vountary provisions, because it is not mandated by aw. According to data provided by the Heath Insurance Association of America, the eve of individua insurance coverage has remained fairy constant for the past decade. In 199 I, individua insurance benefits totaed $2.6 biion (tabes 2 and 6). However, some part of this amount may represent payments made beyond the first 6 months of disabiity. Occupationa Iness or Injury- Workers Compensation Workers compensation programs cover workers in the private sector, and State and oca empoyees in a 50 States, the District of Coumbia, Puerto Rico, and the Virgin Isands. Two additiona programs cover Federa Government empoyees and ongshore and harbor workers. Workers compensation programs protect workers and their famiies against both wage oss and medica care costs resuting from work-reated inesses or injuries. Survivor benefits are paid when disabiities resut in death. At this time, we cannot separate these funds between pubic sector and private sector expenditures. The empoyer s cost of providing coverage varies according to risk, industria cassification, and experience rating. Coverage for workers compensation programs incuded about 93.6 miion workers in I99 I, with $25.3 biion paid in wage-oss compensation. Of this amount, it is estimated that $13.4 biion was paid for short-term income oss, that is, up to 6 months of benefits. These benefits were paid by private insurance carriers, by State funds, or by sef-insuring empoyers, as determined by aws in each State. I However, as previousy discussed, some part of these disabiity benefits may have been paid to persons who were no onger in the currenty empoyed popuation. Genera As.si.stance governments in 36 States, the District of Coumbia, Guam, Puerto Rico, and the Virgin Isands. There is no uniformity of funding patterns between and among the jurisdictions that independenty administer the programs. Amost one-fourth of program costs are financed by oca governments. Genera Assistance is a ast resort for needy persons who do not quaify for Federa financia assistance. Some jurisdictions require that the benefits be repaid when permitted by financia circumstances. Information about Genera Assistance is imited because there are no reporting requirements and no centraized data base. It is estimated that about 300,000 temporariy disabed persons received benefits under Genera Assistance programs in Athough payment data have not been coected since 1980, the tota amount is compara- tivey sma-perhaps spent on short-term Summary $68 miion was disabiity benefits for This note has reviewed the protection of workers against income oss during the first 6 months of iness or injury. The nationa income oss due to shot--term sickness and disabiity during the first 6 months of iness, as expressed by pre-tax wages, was about $69.6 biion in 1991, Of this amount, about $46.5 biion (66.8 percent) was repaced by income-protection programs, incuding paid sick eave; group insurance; temporary disabiity insurance, under statutory State provisions; individua insurance; workers compensation; genera assistance; and the 6th month of the Socia Security Disabiity Insurance program. In I99 I, within Tabe 5.-Estimated vaue of forma paid sick eave in the private sector. and in Federa, State, and oca government empoyment, Types of empoyment I Tota vaue of sick eave._..,_,. $20,9 17 $ $24.20(: C; Private indust~ _._._._._ , Pubic empoyment._..._._.._._ II Ii Federa2 _._._._._._._,_._,_,.,...,., I State and oca3 _._._._._._._._..,,..,.,..._._ 7, JO It is estimated that private industry workers vith sick eave protection recri\e an abcragc of.! dabs 01 paid sick eave per year. excuding other protection. and 2 4 days nhen they have other group protection It is estimated that Federa empoyees use paid sick cavc of 8 da) s per yar on the a\ cragc ti)~ nonoccupationa sickness. which is equivaent to 3 percent ofpayro Federa civiian payro data \\crc obtained from the Survey ofcurrent Business. and were mutipied b) 3 percent. Average annua saary of State and oca workers is obtained from the S.n-\e> o ( trrcnt Hu~rne~r. and is mutipied by the number of fu-time equivaent empoyees. I hi\ is mutipied b!, h.i (00 pcrccnt CII the 7-day work-oss). and divided by 255 days. Tabe 6.-Benefit payments by private insurance companies and sef-insurers. 1988%9 1 Type of insurance co\ eragc Tota benefits paid..... Paid under vountary provisions... Group insurance... Individua insurance... Sef-insurance~... Paid under temporary disabiity insurance Group insurance..... Sef-insurance~ $ I X $5.41 I.7 ss I 4.3 IO I I.5x X I X41.4 X85.6 )?I x 393 -I X 52x 1 Genera Assistance is funded and Not covered by temporary disabiity insurance aws. administered entirey by State and oca Incudes some union-management pans as we as sef-insurance b) empoyer\ - Socia Security Buetin Vo. 57, No. 3. Fa

5 the private sector, wage and saary workers ost $47.2 biion because of nonoccupationa inesses or injuries, of which $17.6 biion (or 37.3 percent) was repaced. Coverage against income ost because of iness in the U.S. workforce favors fu-time professiona and technica empoyees with onger service in arge or medium firms, and especiay favors pubic sector empoyees. The owest eve of coverage is provided to part-time empoyees with imited seniority who work in production and reated areas in sma, private estabishments. About 70 percent of wage and saary workers in the private sector have some protection through their empoyment against earnings osses caused by shortterm iness or injury; 44 percent of these workers have short-term disabiity insurance, and haf have sick eave coverage. Notes See Danie N. Price, Cash Benefits for Short-Term Sickness: Thirty-five Years of Data, , Socia Security Buetin, Vo. 45, No. 5 (May) 1986, pp The surveys are Empoyee Benefits in Medium and Large Private Estabishments, Empoyee Benefits in Sma Private Estabishments, and Empoyee Benefits in State and Loca Governments, See References, beow, for citations. 3 See Department of Labor, Bureau of Labor Statistics, BLS Reports on Empoyee Benejts in the United States, , Summary 934, June 1993, tabe 1. 4 See Department of Labor, Bureau of Labor Statistics, Empoyee Benefits in Sma Private Industry Estabishments, Buetin 2388, Aso see Department of Labor, Bureau of Labor Statistics, Empoyee Benejts in Medium and Large Private Estabishments, Buetin 2422, See Rethinking Disabiity Poicy: The Roe of Income, Heath Care, Rehabiitation and Reated Services in Fostering Independence, Preiminary Status Report of the Disabiity Poicy Pane, Nationa Academy of Socia Insurance, March 1994, p, 47. See Department of Labor, Bureau of Labor Statistics, BLS Reports on Empoyee Benefits in the United States, , Summary 93-4, June 1993, tabe 2. See Department of Commerce, Statistica Abstract of the United States 1993, Tabe No Days of Disabiity, by Type and Seected Characteristics: 1970 to 1990, 1993, p a See Office of Personne Management, Work Years and Personne Costs: Executive Branch United States Government, Fisca Year 1992, p See Wiiam J. Neson, Jr., Workers Compensation: Coverage, Benefits, and Costs, , Socia Security Buetin, Vo. 56, No. 3 (Fa), 1993, pp References Department of Commerce Statistica Abstract of the United States Tabe No Days of Disabiity, by Type and Seected Characteristics: 1970 to Printing Office, p Survey of Current Business. Vo. 73, No. 8 (August). Washington, DC: U.S. Government Printing Office. Department of Labor, Bureau of Labor Statistics Empoyee Benefits in Medium and Large Private Estabishments, Washington, DC: U.S. Government Printing Office BLS Reports on Empoyee Benejts in the United States, Printing Office Empoyee Benefits in Sma Private Estabishments, Printing Office Empoyee Benefits in State and Loca Governments, Washington, DC: U.S. Government Printing Office. Heath Insurance Association of America Source Book of Heath Insurance Data, Washington, DC. Price, Danie N Cash Benefits for Short-Term Sickness: Thirty-five Years of Data, , Socia Security Buetin, Vo. 45, No. 5 (May), pp The Nationa Academy of Socia Insurance Rethinking Disabiity Poicy: The Roe of Income, Heath Care, Rehabiitation, and Reated Services in Fostering Independence. Preiminary Status Report of the Disabiity Poicy Pane, pp Socia Security Buetin Vo. 57, No. 3 Fa 1994