Those so-called “zero-cost” workers’ compensation claims? They really aren’t zero-cost, according to a study published in the December Journal of Occupational and Environmental Medicine.
Although zero-cost claims result in no payment from the workers’ compensation systems, they push costs higher for employee group insurance plans, the study’s authors conclude.
Nationwide, zero-cost workers’ compensation claims could cost group health insurance plans more than $200 million per year, according to the study by Abay Asfaw, Ph.D., and his colleagues at the National Institute for Occupational Safety and Health.
The researchers analyzed data on more than 12,000 injured workers who filed for workers’ compensation insurance from 2002 through 2005. Sixteen percent of the claims were zero-cost claims – that is, they resulted in no workers’ compensation payments.
Use of and payments from the employees' group health insurance increased after workers’ compensation claims. That was so for zero-cost claims as well as claims resulting in payments, according to the researchers.
But the zero-cost claims were associated with significantly greater increases in costs to group health insurance, after adjustment for other factors. The increase was largest for outpatient care, with an estimated increase of approximately $400 per claim.
"Our national estimate showed that zero-cost [workers’ compensation] claims added $212 million in medical bills to group health insurance per year," the researchers assert. Because their data may miss some occupational injuries, they suspect that the true economic impact is even higher.
The study adds to previous evidence suggesting that non-workers’ compensation insurance – including employee health plans and public insurance – covers at least part of the costs of work-related injury and illnesses.
"If [workers’ compensation] provides inadequate coverage … workers will seek treatment using other insurance," Asfaw and his co-authors conclude. "Our key finding is that zero-cost WC medical claims have repercussions for other insurance systems and society, and their economic implications are substantial."