New Study Suggests "Zero-Cost" WC Claims Paid by Health Plans

A study published in the December issue of The Journal of Occupational and Environmental Medicine concludes that so-called "Zero Cost" Workers Comp claims end up being paid under employer health insurance plans.

The report suggests that this reflects an inadequacy in Workers Compensation coverage, which doesn't ring true with me. If this study really holds up to analysis--that is, if genuine work-related injuries and illnesses are being fobbed off on health insurers, it would suggest to me that the problem would lie not in Workers Compensation coverage, exactly, but in the hurdles some insurers might be placing in the way of injured workers.

But some commentators have suggested that the authors of the study may be misunderstanding how Workers Compensation insurance works. It may be, these critics suggest, that claims that initially are put forward as being work related just don't pass muster when examined more carefully by claims adjusters. After all, it is not unheard of for a worker to try and pass off as work-related an injury that actually happened on the worker's own time. So it would be entirely appropriate for such claims to be handled instead by health insurance programs rather than Workers Compensation insurance.

After all, just because a claim is initially submitted as Workers Compensation, it doesn't mean that the facts of the situation will ultimately support such a claim. Even with the best of intentions, there can be misunderstandings about what is and is not genuinely work related, under the specific statutes of a given state. An injury in a parking lot, for example, before a worker has actually entered the workplace, could generate an initial claim under Workers Comp, only to be ultimately rejected by the WC insurer or a state's WC judges.

So it is not entirely clear to me that the methodology used here is as airtight as it might be. I'll try to get a copy of the actual report (rather than just relying on press reports) and offer a more detailed analysis at a later date.