Workers’ compensation programs are expensive. They must cover injuries that can range from minor, single occurrence incidents to chronic or catastrophic injuries that leave a worker permanently disabled.
A roofer who has fallen at work and is severely injured is easy to identify as having suffered a work-related injury. A nurse who may have to assist moving patients from beds, chairs or gurneys, and has done so for 20 years and is suffering from back problems and has deteriorating disks, is less clear.
She may have suffered incremental injuries during her career or she may have also engaged in activities outside of work that contributed to the back issues. Are her injuries work related? If a doctor may receive more reimbursement from the workers’ compensation program than from a group healthcare plan, he or she may be tempted to assign the injuries to the workers’ comp system.
Some states control these costs by limiting doctor reimbursement with a schedule. If that schedule is close to what insurance outside of workers’ comp will pay, it reduces the incentive for a doctor to move a claim. Of course, some of the claims are difficult or unclear, and the real solution would be a better means to identify the source of the injury.
While many employers may think better identification the source of workplace injuries, would lower their insurance costs, other employers realize how damaging their work is to their employee’s bodies, and their premiums would likely increase if that damage could be appropriately tracked back to business.
However, many of these issues are political in nature and that is why Wisconsin has yet to create fee schedules. The competing interests of doctors, business owners paying workers’ compensation insurance premiums, the insurance companies, and the politicians means sometimes the injured workers, who just want their injuries to be treated so they can return to work, is lost in the mix.
Source: businessinsurance.com, “Following the money on injuries?” Donna Mahoney, May 8, 2016