The battle between workers’ compensation benefits and group health care/STD is going to continue.
Editor’s comment: When you offer STD and group health care, don’t “deny” WC claims—just drive them into the lower cost path. Our research indicates workers are continually analyzing and comparing disability benefit offerings against potential workers’ compensation payments to learn which of the two systems provides easier and more lucrative benefits. Then they are steering disability and injury claims into respective the work comp system or disability benefits area, depending on which would provide the greatest or possibly longest-running payments.
Our sources and research indicate “benefit shopping” is driving some employer’s severity and exposures higher and higher. The concept is being fueled by the biggest recession of our lives and workers who face layoffs and an uncertain future.
Our focus is to avoid fully and adequately investigating a claim and then “denying” it as workers’ compensation. We feel this practice unnecessarily acts like a “slap in the face” to someone who truly has a problem. We feel you are much better served to try to keep the employee happy by letting them know you have a system that is a viable alternative to workers’ compensation. The only significant difference between group health care and STD in relation to workers’ compensation is permanency—in Illinois, avoiding PPD is a win-win for Illinois business. And most health care and STD systems already implement UR and lost time in a way our Illinois WC system has not yet caught up to.
So when you get a new claim of injury, have everyone fill out your accident form and HIPAA-compliant release. If you fully investigate and learn there are questions about the compensability of the claim under WC, don’t “deny” it, just shift the employee’s focus to your STD and group health care systems.
If you have thoughts and comments about this approach, please send a reply.
