The 28th annual workers’ compensation report produced by the National Academy of Social Insurance provides the only comprehensive data on workers’ compensation benefits, coverage, and employer costs for the nation, the states, the District of Columbia, and federal programs.
Executive Summary
In 2023, U.S. workers’ compensation programs covered nearly 150 million jobs and close to $11 trillion in wages, exceeding the levels from prior to the COVID-19 pandemic. Recovery has been uneven across states, with the fastest covered job growth concentrated in the South and Mountain West, while several states remained below their pre-pandemic employment levels.
In keeping with the past two years, covered wages and jobs increased nationally, with Texas experiencing the largest percent increase in covered jobs (3.8%) and New Mexico having the largest percent increase in covered wages (15.9%). No state experienced a decrease in covered jobs. Alternatively, New Hampshire was the only state exhibiting a decrease in covered wages (1.7%). Covered jobs increased for federal employees, diverging from the decline observed in recent years. There were national aggregate increases in benefits paid and employer costs between 2022 and 2023; across the five-year study period, however, there was a decrease in aggregate medical benefits paid.
Nationally, total benefits paid ($64.1 billion), including medical and cash benefits, and employer costs have continued to decrease when adjusted for covered payroll ($0.98 per $100 covered payroll). This masks differences across states: 13 states experienced increases in cash benefits per $100 of covered wages between 2022 and 2023 (Nevada having the largest increase at 18.9%, transitioning from decreases observed over the past 2 years). Of the 38 jurisdictions with decreases between 2022 and 2023, West Virginia experienced the largest change (19.5%).
Medical benefits accounted for more than 47% of the $64.1 billion paid in benefits. In keeping with recent trends, most jurisdictions (31) experienced a decrease in medical benefits per $100 of covered wages between 2022 and 2023. The largest decrease was in South Carolina (17.4%). Out of the 20 jurisdictions with increases, the largest increase came from Massachusetts (5.9%). Both South Carolina and Massachusetts demonstrated a shift in the opposite direction (increase to decrease or vice versa) when compared to the prior year-over-year change (2021-2022).
Taken together, 36 jurisdictions experienced a decrease in total benefits paid per $100 of covered payroll between 2022 and 2023; the largest drop came from Mississippi (13%). The largest increase over that period came from Nevada (12.5%), following the state’s increases in both cash and medical benefits paid per $100 of covered payroll.
Almost every jurisdiction (43) experienced a decrease in employer costs per $100 of covered payroll between 2022 and 2023. The largest of these decreases came from Idaho (17%). Of the 7 jurisdictions experiencing an increase, the three biggest increases were in Nevada (3.1%), Oregon (2.7%), and New Hampshire (2.4%). Hawaii’s yearover-year measure was unchanged.
Coverage continues to be dominated by private insurers (55.6% of benefits paid). Self-insured employers account for about quarter of benefit payments (25.6%) with the 22 state funds (13.3%) and the federal government (5.5%) making up the remainder and mirroring the 10-year average pattern.