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Study Conducted by Massachusetts-Based Research Institute Reveals the Cost of Employee Injuries May be Needlessly Shifted to Workers’ Compensation Insurance

Recently, Massachusetts’ largest health care insurer reportedly began advocating in favor of major changes to the way insurers pay for health care. Since then, the company has signed three of Massachusetts’ biggest health care providers to contracts that would set patient budgets and supposedly encourage hospitals and doctors to keep patients healthy in order to avoid costly facility stays. The new contracts are purportedly geared towards slowing the rising costs associated with medical care across the Commonwealth. According to a recent study, however, this trend may unintentionally shift costs from group insurance plans to workers’ compensation insurers.

The Massachusetts-based Workers’ Compensation Research Institute (“WCRI”) claims employers in the Commonwealth and across the United States who choose to provide workers with health care benefits using capitation-based contracts, which provide for a set payment per plan member regardless of the number of medical visits, may actually cost themselves money. Under the Massachusetts Workers’ Compensation Law, established medical reimbursement rates are currently higher than those offered through health provider insurance contracts or self-insured employers. Since it is often difficult to determine whether a worker’s soft tissue or other commonplace injury is work-related, physicians are provided with discretion regarding the underlying cause of an employee’s injury. In many cases, it is in a medical provider’s best interests to classify a worker’s harm as related to his or her job.

According to WCRI CEO Richard Victor, workers’ compensation disability payments are typically paid much sooner than private, non-occupational disability insurance plans that may require a hurt individual to wait up to 90 days to receive benefits. In addition, workers’ compensation disability payments are often paid for longer periods than those benefits provided by a private company. The recent WCRI study also found that injuries sustained by employees who were covered by capitation-based health plans were 11 percent more likely to be deemed work-related. Additionally, that number increased significantly in states where more than 22 percent of employees were covered by such plans.

Victor stated the disparity may not be easily recognized by many companies because the department that handles health care benefits may not be the same one that purchases workers’ compensation insurance coverage. This means it may appear the employer is saving money on overall health care costs, even though workers’ compensation expenses are increasing. The WCRI study supports this claim. For example, if three percent of soft tissue injures in California were shifted to the workers’ compensation system, employers would incur a $225 million increase in overall costs. The WCRI claims similar changes in Iowa would result in increased workers’ compensation expenses of about $25 million, and Pennsylvania would see costs rise by approximately $100 million.

If you were hurt at work in Boston, you should contact a caring Suffolk County workers’ compensation attorney who can help you protect your rights. The hardworking lawyers at Kantrovitz & Associates, P.C. are available to help you recover the benefits you deserve based on the severity of your workplace accident injuries. To discuss your right to receive workers’ compensation benefits with a knowledgeable advocate, do not hesitate to contact Kantrovitz & Associates, P.C. online or give us a call today at 800-367-0871.

Additional Resources:

Trendy Health-Care Payment Scheme Hikes Workers’ Compensation Costs, by David McCann,

Blue Cross extends revised contracts for care, by Priyanka Dayal McCluskey, Boston Globe

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