The connection between high health plan deductibles and workers' comp claims
Workers who have a high-deductible health plan are more likely to file under workers’ compensation when they're injured.
Workers who are injured on the job may or may not file for workers’ compensation, but among the factors that influence that decision — and tip it toward filing a comp claim — is the level of the deductible in their employer-provided health plan.
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That finding comes from a new report from the Workers Compensation Research Institute (WCRI), which finds that as deductibles rise, employees are more likely to turn to comp claims rather than their own coverage.
Increasing cost of deductibles
“In years past, workers may have chosen to have a work injury covered within their group health plan,” says John Ruser, WCRI’s president and CEO. “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.”
According to the report, workers who have a higher deductible from their group health plan when they’re injured are not only more likely to file under workers’ compensation than under group health insurance, workers who have sustained soft-tissue injuries are even more likely to turn to workers’ comp rather than their own health coverage when deductibles are higher for the latter.
5.3% increase in workers’ comp claim volume
When injured workers have an average remaining deductible of $550 on their own health coverage, the report adds, they’re approximately 1.4 percentage points more likely to tip the scales in favor of filing a workers’ compensation claim than if their own coverage deductible is zero. And that results in an increase of 5.3% in workers’ compensation claim volume.
States in which workers can choose their initial provider are the ones seeing the most concentration in the rise in filing workers’ compensation claims. That could possibly be due to the ability within workers’ compensation of workers to stay with their group health doctor in these states.
The study also estimated the increase in workers’ compensation volume from the growth in high-deductible group health policies, and found that “the increase partially offsets the overall decline in workers’ compensation claims seen over the past decade.”
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