Group Health Plans Pay for ‘Zero-Cost’ Workers’ Compensation Claims: Study

December 9, 2013
injured_worker

  • December 9, 2013 at 1:44 pm
    Doubting Thomas says:
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    This is the same study that was tried two years ago and I debunked that one. The claims could have been rightfully denied or the employee decided to not pursue a claim that happened off the job. This study is highly questionable. It would have helped if the author knew how WC works. How many WC claims if pursued actually get fully denied? Is this bunk statistics?

    • December 9, 2013 at 2:10 pm
      Agent says:
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      I also doubt. Employees are always trying to file on Workers Compensation knowing their is no deductible, co-insurance etc. Mystery injuries abound and if the WC carrier does an investigation, they do catch some perps trying to test the system. They often find out the employee is lying about getting injured on the job. Illnesses are often non job related. I wonder what will happen next year when Groups are being cancelled when Obamacare gets them.

  • December 9, 2013 at 2:19 pm
    Huh! says:
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    It isn’t that Work Comp coverage is inadequate. It’s that the injuries are not work-related and/or do not arise out of the scope of the individual’s employment.

  • December 9, 2013 at 3:28 pm
    Center Point says:
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    Interestingly, it is another reason why people should have basic healthcare coverage, whether provided by the employer or purchased on their own. If they do not have healthcare coverage, an off duty injury may be converted into an on the job accident or sprain.

    • December 9, 2013 at 5:17 pm
      Agent says:
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      You are not saying some employees would try to game the situation, are you? No individual coverage, no Group Coverage = File on Workers Compensation. Hey Supervisor, I accidentally slipped and fell in the warehouse. No, no one saw it! Now, I can’t work and will probably be off at least 3 months. I need to have an MRI, Cat Scan, Xrays, blood work.

  • December 9, 2013 at 5:10 pm
    Paduda says:
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    After reading the entire study, I’m thinking the conclusion has merit. Notably, the researchers only analyzed medical expenses for individuals with accepted workers’ comp claims. Thus, a claim did exist, and had been accepted by the responsible party.

    I’d suggest a full read of the entire study may help those skeptical about the conclusions better understand their validity.

    That said, the total figure amounts to less than 1 percent of work comp medical spend. Nothing to get too exercised about.

    • December 10, 2013 at 8:27 am
      Doubting Thomas says:
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      From the study – they should have considered reportable only claims.

      The results of this study should be interpreted with limitations in mind. First, the data we used were restricted to employees covered by employer GHI. Thus, this study did not examine the effects of zero-cost WC medical claims on workers with individual coverage, or without any coverage, which could be substantially higher than our estimate. Second, because of lack of data, we did not consider injured workers whose WC medical claims were completely rejected. Third, we did not have any information about why the WC medical claims were zero. If most of zero-cost claims were not work-related, our results could overestimate the impact of zero-cost WC medical claims on GHI. Future detailed national studies are needed to quantify legitimate WC claims, using International Classification of Diseases codes and other methods to calculate the costs that would be shifted from WC to other insurance systems, workers, and the public. Fourth, because of lack of information, we could not control for the effects of personal characteristics such as education, race, income, and comorbidity. Preexisting health conditions such as diabetes could aggravate the negative effects of workplace injuries on the health status of injured workers, and this might add additional burden on the GHI. Finally, our data came from large employers who are clients of Thomson Reuters, and these employers are more likely to be self-insured for their GHI and, depending on the states where they are operating, for WC insurance. Therefore, our findings may not be generalizable to all employers.

  • December 10, 2013 at 5:32 am
    Brent McGillis says:
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    A study done by the Hacks and Quacks network of crony WCB doctors, Donald Duck data, nice.(sic) I fell off a beam in front of the Company Owner and the GC Foreman, and to this day I rely on AISH to pay for my medications, and to provide support because our WCB system is systemically infected with corruption right to the very Top. Taxpayers in Alberta, the Tar Sands mecca pay for my care and my rent. That is what WCB downloading Seriously Injured Workers onto taxpayer Healthcare systems looks like, this is SOP in Canada. Foreign owned Mining and Oil corporations like Exxon, Sinopec, Total, Shell pay a dollar an hour for WCB. They have NO interest in helping injured workers, they want their costs kept artificially LOW. Keystone XL will perpetuate this WCB punishment. A WCB Quack doctor tells my MD every time he calls them that I never hurt my neck at work, and that my file is closed permanently. This is what a WCB Quack doctor can do to destroy your life as a injured worker. Ruined my life, I live in poverty on the public dime, how fare is that to taxpayers huh?

  • December 10, 2013 at 10:47 am
    Megs says:
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    I think that WC shouldn’t even exist unless someone is actually injured from an actual machine that belongs to their business, because technically that machine is theirs and not your own (for your own personal fault) I read the earlier comment saying “Oh i fell on the floor and i’m going to need to be out for 3 months” Well.. That is your own fault. Or other people’s fault for not cleaning up their mess on the floor. The company shouldn’t pay for that because it wasn’t their fault, it was employees just like yourself. Then again, I probably make little to no sense, I’m only 18 years old and in college right now doing research on this. So perhaps I should do more research…. Peace.

    • December 10, 2013 at 3:57 pm
      Agent says:
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      Megs, you really need to do more research because you sure don’t understand how Workers Compensation works with employers and employees.

    • December 11, 2013 at 10:23 am
      Libby says:
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      Megs:

      Not sure this forum is a good place for actual research. Here’s a good start:

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1888620/

      Also your state’s Department of Labor site probably has some good information, too.



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