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Workers Comp Study Ask For Adjuster or Risk Manager Opinion?

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A Great Workers Comp Study With No Claims or Risk Input

A recent Workers Comp study on Zero Cost Claims makes me wonder if the researchers decided to ask an adjuster or risk manager their opinion before they published the article.  I found the study in a recent Insurance Journal article.  

Wikimedia Foundation Workers Comp Study Research Logo
Wikimedia – DarTar

Reading through the study, one can quickly see that no Workers Compensation personnel were consulted.  The database used was from a Thomson Reuters database on self insureds.  As we all know, the self-insurance community is a different animal from the rest of the WC world.   

If an employer actually took the time to report the claim as WC, then the employee would have been referred for treatment under WC.   Almost all employers that I have ever seen paying WC claims under health would not have bothered filing any type of WC forms or recording the injury as work-related.   One cannot read the article without wondering if the authors were trying to say the employers were shifting WC costs to their health insurance.  

The researchers were thorough in their analyses.  There is no doubt in their numbers.  The first thing I usually do is go directly to the bottom of a study to see if there were any study limitations and what references were used to draw their conclusions.  

The study did not consider :

  • Workers with individual health coverage, or without any coverage
  •  Denied claims which would overestimate the impact of zero-cost WC medical claims. 
  • Preexisting health conditions such as diabetes could aggravate the negative effects of workplace injuries on the health status of injured workers
  • Data came from large employers who are clients of Thomson Reuters, and these employers are more likely to be self-insured for health or WC.  Therefore, their findings may not be generalizable to all employers.

One of the main references used in the study was from a source article and study that I questioned in this blog two years ago.   

Diagram of Workers Comp Study Zero Cost Claims
Wikimedia Commons – Toby Hudson

 One area that would have been mentioned  if they had interviewed just one risk manager or workers compensation claims personnel is that employers file many reportable-only claims where the employee does not seek treatment.  I am unsure of how this would have directly affected the study, but they should have covered that fact in detail.   

 Is the study worth reading?  I do think it is worth your time.  If you decide to read it, please feel free to draw your own conclusions.  

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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