ACA Penalty May Not Deter Workers Comp Claims
What if a worker decided to pay the ACA penalty and file a WC claims for medical treatment? The Affordable Care Act (ACA) may cause an unintended spike in Workers Compensation claims.
One of the concerns over the years in claims departments is an employee substituting Workers Comp for health insurance. The ACA may also cause medical treatment rationing.Now that almost two million health policyholders that were previously insured have been dropped by their health insurance carrier, could Workers Comp become a safety-net type of accident insurance? Claims for many illnesses would be immediately denied by Workers Comp carriers .
The “Monday Morning” claimant is one of the huge red flags when a claim is filed for benefits. A very limited amount of ailments could be filed by reporting Workers Comp claims. Any home accident could be reported as a claim upon returning to work the next day.
An adequate claims investigation will probably uncover the fact that the accident was not related to work. One of the best places to look is in the history of the injury as recorded by the original treating physician in his/her notes. One very obvious area is the original date of treatment. The date may not necessarily match the date of the injury.
Communication between the employer and physician will be tantamount to avoid having to pay for non-work related treatment. One of the Five Keys To Saving on Workers Comp Claims is having a designated original treating physician. Some states do not allow the choice of treating physician by the employer. Other states such as California allow for medical treatment panels or MPN’s.
A rash of Workers Comp claims may not occur due to the ACA. However, only two or three claims can wreck what was previously a good Workers Compensation program.
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