Most medium-to-large employers in the US are self-insured, although big insurers manage the plans for them. When I was working at a factory with a couple of thousand employees, one of them crushed her leg in a motorcycle accident and required a total amputation. Shortly thereafter (and before her return to work) we had an all-hands meeting where they emphasized the importance of vehicular safety during our off hours. HR didn't name any names, although everybody knew who they were talking about.