High Health Deductibles and Workers’ Comp Claims

Are employees injured at work more likely to file under workers’ compensation instead of group health insurance when their group health plan has a higher deductible?

The Workers Compensation Research Institute (WCRI) found evidence they do in a new study it says has great relevance since the number of workers in health insurance plans with high deductibles is growing.

“In years past, workers may have chosen to have a work injury covered within their group health plan. 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,” said John Ruser, WCRI’s president and CEO.

Injured workers consider a variety of factors in deciding whether to file in group health or workers’ compensation. WCRI’s new study, Do Higher Deductibles in Group Health Plans Increase Injured Workers’ Propensity to File for Workers’ Compensation?, finds evidence that injured workers are more likely to file in workers’ compensation when they face higher out-of-pocket costs in group health plans.

The following is a sample of the study’s major findings:

• Workers with a higher remaining group health deductible at the time of injury are more likely to file under workers’ compensation than under group health insurance.
• Injured workers are about 1.4 percentage points more likely to file a workers’ compensation claim when they have a remaining deductible of $550 (the average) compared with a zero deductible at the time of injury, amounting to a 5.3 percent increase in the workers’ compensation claim volume.
• The increase in propensity to file for workers’ compensation coverage in response to higher deductibles is even greater for injured workers with soft tissue conditions.
• The increase in filing for workers’ compensation coverage is concentrated in states where employees can choose their initial provider. This may reflect the ability within workers’ compensation of workers to remain 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. The increase partially offsets the overall decline in workers’ compensation claims seen over the past decade.

The study was authored by Olesya Fomenko and Jonathan Gruber.