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Workman’s Compensation

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Ben Kalinkowitz
September 26, 2017

After a month of physical therapy, Mr. Smith* complains to me he is still in a lot of pain and his shoulder isn’t getting any better. If he were a regular patient, my next steps would be simple: call his physician, talk about Mr. Smith’s progress and send Mr. Smith for further follow-up. However, Mr. Smith was injured on the job, making the process much more complicated. In addition to his physician, I have to speak with a case manager, and then wait while a claims adjustor (who may not have any clinical training) determines if this particular case warrants further follow-up. Ultimately, the odds of Mr. Smith getting timely care are low, and helping him heal and return to his normal life and work gets harder. Welcome to the world of worker’s compensation, the dark corner of suboptimal healthcare that is in desperate need of reform.

Worker’s compensation programs in the U.S. began at the end of the nineteenth century, when being injured on the job meant accruing expensive medical bills while losing the means to pay for them. Requiring businesses to provide medical care for on-the-job injuries and to compensate workers while they were recovering was a major legislative achievement. Unfortunately, this advance in workers’ rights has not kept pace with changes in health care delivery. While the original program of worker’s compensation was meant as a stopgap for largely uninsured workers, by 2016, over 90 percent of Americans were insured — the majority through their employer. A separate care system has become unnecessary and costly for all involved.

Today, many employers provide health insurance twice: once as part of routine health insurance, and once for work related injuries. But the two insurance pools operate differently, with vastly different risks and consequences. Routine health insurance doc-moneypools risk across all the insurance company’s products, meaning one employee’s sudden cancer diagnosis will have virtually no impact on the employer’s costs. However, worker’s compensation is more similar to auto insurance: each claim increases the employer’s premiums. In this way, the injured employee becomes a costly expense, creating a disincentive for employers to file claims. Once claimed, the injured worker is still at a disadvantage; unlike health insurance, where the user is both the patient and the customer, worker’s compensation cases result in a customer (the employer) and patient (the injured worker). This system casts the employee as a broken machine the employer has sent out for repair, and not an injured human being with input about his own care.

Unsurprisingly, outcomes for worker’s compensation injuries are worse than the general public. While research speculates this may be due to the severity of on-the-job injuries and employees looking to extend their paid injury leave, they fail to recognize delayed and substandard care as a significant problem. When an employee receives worker’s compensation benefits, they become ineligible for care for the injury under their regular health insurance. This prevents an employee from getting a second opinion after seeing a workers compensation approved practitioner, making it harder for them to advocate for themselves. Simultaneously, worker’s compensation insurance companies often try to limit their own liability by blaming workplace injuries on preexisting conditions. And while injury is technically not a legally reason for termination, if an employee happens to be fired during their course of treatment, they must continue to rely on their former employer for worker’s compensation care, who will be even less inclined ensure quality care.

The medical care provided by worker’s compensation is no longer living up to its goals or mandate. Now the majority of Americans have health care coverage under the ACA, it does not make sense for employers to pay for health care twice, especially in order to create a two-tiered system of substandard care. Separating medical treatment for a work related injuries results in worse outcomes for both the employee and the employer. Moving worker’s compensation health care to the regular health insurance market will benefit both employers and employees, bringing lower health care bills to the employer and more timely and effective care to employee. While adding work-related injuries to their health insurance plan may raise costs for the employer in the short term, it should eventually lower their overall health-related costs, while simultaneously lowering the risk of increasing costs as a result of a single job site injury. Overall care will improve: the regular healthcare market has a financial stake in reducing cost for the whole person, rather than providing care for a single body part or injury; unnecessarily delaying treatment hurts the insurer as well. It is time to integrate worker’s compensation care into the larger risk pool of employer provided health care.

*name and some details have been changed to protect the patient.

Author: Benjamin Kalinkowitz, PT, DPT, MPA is a recent graduate of the Masters of Public Administration program at the University of Nebraska at Omaha. He is also a practicing physical therapist in New Jersey.All views expressed are the author’s alone. Twitter: @benkalinkowitz Email [email protected] 

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