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Health care reform and comp claim frequency


The body of research into whether employees covered under non-occupational health plans file fewer or more work comp claims is so thin it's hard to draw solid conclusions from it.

Comp Time looked into this matter after a source said in a Business Insurance story published this week that there is a possibility that as more people gain health care coverage under President Barack Obama's new reforms, comp claim frequency could actually increase rather than decrease, as some might expect.

But where are the studies backing up the possibility that comp claim frequency might rise as more workers get health plan coverage?

Comp Time asked various sources including NCCI Holdings Inc. and the California Workers' Compensation Institute if they know of studies linking the availability of non-occupational health care coverage and the filing of comp claims.

They either referred Comp Time to discussions Joe Paduda posted on his Managed Care Matters weblog or to a Rand Corp. study that is at least 5 years old now.

Comp Time called the Rand researchers to ask if they know of studies on the subject other than their own work. They recalled one, perhaps two other studies that predate their research.

And the Rand study, “How Does Health Insurance Affect Workers' Compensation Filing” found that employer characteristics are a more significant determinant for comp claim filing than whether employees are covered under a health plan.

That means an employer providing a health plan might also be more supportive when an injured worker files a comp claim, and thus encourage more claims, than a mean old boss that doesn't provide health coverage and discourages injured workers from filing claims.

Whether health care coverage encourages or discourages comp claims is something comp observers talk a lot about, but don't have much evidence to go on, said Robert Reville, a labor economist and researcher at Rand known for his work comp research.

Usually, you need a solid body of research literature comprised of multiple studies before you can make broad scientific conclusions about a subject.

“You need to look for critical mass and this is definitely not a literature (or subject) with critical mass” Mr. Reville told Comp Time.

Meanwhile, the discussion continues, stoked by President Obama's new health reform laws.

An insurance company senior claims professional recently posted on the Workers' Compensation Forum hosted by Mark Walls that he expects claims frequency will decrease as more employees gain health insurance.

The senior claims professional said he expects frequency will decline because he sees numerous comp claims that would not get reported and approved as work injuries if the claimants had health coverage.

That makes sense.

But Mr. Reville thinks there is also a possibility that frequency could rise. More people seeking medical attention could check the doctor's intake form box that asks if their injury is work related, Mr. Reville said.

Yet as more people get health coverage and get their health issues treated earlier, comp claim severity could simultaneously drop, Mr. Reville added.

It's a very complicated issue, Mr. Reville said. And with the new health reform law we are about to embark on a huge experiment that could provide some data on how health coverage impacts comp claims, he added.