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High-deductible group plan may up likelihood of comp claim: WCRI

Workers comp claim

Injured workers are more likely to file workers compensation claims when they have high-deductible group health plans, according to a study released Monday by the Workers Compensation Research Institute.

The WCRI study, Do Higher Deductibles in Group Health Plans Increase Injured Workers’ Propensity to File for Workers’ Compensation?, authored by Olesya Fomenko and Jonathan Gruber, found that injured workers are about 1.4% more likely to file a workers comp claim if they have a remaining group health deductible of $550 or higher vs. no deductible at the time of injury, which amounts to a 5.3% increase in the worker comp claim volume.

Cambridge, Massachusetts-based WCRI researchers found that the increase in soft-tissue workers comp claims — when the source of the injury was less likely — was much larger than comp claims relating to trauma, and found an overall filing increase of 6.2% for these types of conditions between 2008 and 2014, and an increase of 3.3% between 2014 and 2017. However, the number of workers comp filings for trauma injuries in response to larger deductibles was 1.5% between 2008 and 2014 and just 0.6% between 2014 and 2017, according to the report.

“In years past, workers may have chosen to have a work injury covered within their group health plan,” John Ruser, WCRI president and CEO, said in a statement. “But the increasing cost of deductibles may cause them to consider having the injury covered ─ where it potentially belongs — in the workers’ compensation system, where there are no deductibles or co-payments for the medical care they receive.”

The study also revealed that states that saw the biggest increase in workers comp coverage filings appeared to be those where employees can choose their initial provider. The researchers speculated that this may be due to the workers’ ability to see their own physicians for their injuries, thereby lowering the cost to them of filing a worker comp claim.

The researchers said their results show that workers “are not forward looking” in making workers comp filing decisions and “pay more attention to out-of-pocket payments at the time of injury.”

Overall, WCRI said the study shows that injured workers are more inclined to seek workers comp coverage to avoid out-of-pocket health expenses when “facing a substantial financial burden” of group health deductibles.





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