Sometimes, injured employees are afraid to file a workers’ comp claim after being injured at work because they fear the specter of retaliation by their employer.
Experts suspect that up to 10% of workplace injuries are never reported because the workers choose to have the injuries covered by their employer-sponsored health plans. Most employers may not be aware of the full extent of their workplace injuries because of this phenomenon.
But, that could change as workers are saddled with higher deductibles and out-of-pocket expenses, according to a new study.
A number of past studies have found that if the costs to workers for having their personal health insurance cover a workplace injury is less than the “cost” to them of filing a workers’ comp claim, they will opt to have their health insurance cover it instead.
Here’s what studies have found over the years:
A 1996 study found that workers without health insurance have an incentive to claim their medical issues are work-related even if they are not, so that workers’ compensation insurance will pay for care. The study also found that if the injury occurs at work, health insurance may deter workers from filing for workers’ comp if they feel there is a cost to filing a claim.
A 2007 study found that a genuine workers’ comp claim can be “costly” to file for a worker if:
– The employer dissuades workers from filing workers’ comp claims because they fear the claims will increase their premiums.
– The injured worker does not want to deal with the paperwork for a workers’ comp claim.
– The individual feels there is a stigma associated with filing for workers’ comp.
A 2003 study of Michigan workers and their physicians found that 70% of injured workers did not file for workers’ comp, and that 36% of the non-reporting injured workers cited having health insurance as a reason they did not.
What could be ahead
The most recent study, by the Workers’ Compensation Research Institute (WCRI), found that injured employees are more likely to file workers’ compensation claims when they have high-deductible group health plans.
The study found that workers with a remaining group health insurance deductible that exceeds $550 are more likely to file workers’ comp claims than if the deductible were less. As more workers find themselves staring at higher health insurance deductibles, they will properly report their workers’ comp claims to their employers.
“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 copayments for the medical care they receive.”
This is likely to add about 5% more claims into the system, the WCRI found.
What you can do
If you suspect that one of your employees has reported a workplace injury for something that happened during non-work hours you should look at the claim to see if it has the hallmarks of a potentially fraudulent claim.
Some warning signs the claim may not be legit include:
There are no witnesses to the incident.
The claim is reported late (usually many days since the alleged injury).
The injury is reported on a Monday morning (which could mean they injured themselves over the weekend).
The injured employee’s story is inconsistent or suspicious.
The incident is only vaguely described, incomplete as to details or out of the norm of the type of injury that might be expected.
The employee engages in sporting and outdoor activities regularly.
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