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US Supreme Court ACA Decision To Affect Workers Comp?

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US Supreme Court ACA Decision Could Affect Workers Comp

The US Supreme Court ACA decision could easily affect Workers Comp.  Let us call it the old Law of Unintended Consequences.

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There are multiple articles on this blog concerning the Affordable Health Care Act (Obamacare) and its possible effect on WC.

For reference some of the articles are:

Would the Workers Compensation industry actually see a spike in claims if the Supreme Court guts the ACA?   My answer would be an unequivocal – Yes.

I have always felt since working my way through the WC claims hierarchy that people are going to look under every stone to find some type of insurance coverage.

A possible scenario in this case would be that all of a sudden someone cannot renew their ACA-sponsored policy.  Who could blame that person for attempting to file a WC claim to receive treatment for an injury that was originally treated under a health insurance policy?  Desperate people do desperate things.

This is not to say these types of claims would ever be accepted by a WC claims department.  However, if the claim is reported, the requirement of a full investigation will still use up a large amount of time for a claims department.

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The states and the Feds have all said they will bring in measures to keep health insurance alive for ACA policies.

However,  would there not likely be a haircut of people covered as the health insurance carriers would only have to look at the Law of Large Numbers to see that a smaller group of health plan participants would prevent the risk being spread among a large enough group.

I am not advocating for or against the ACA.  Numbers do not lie, unless you look at the wrong numbers.

One only has to look to the opinion proffered by Dr. Richard Victor- the outgoing Director of WCRI.  He presented a very interesting slant on how WC and the Affordable Healthcare Act would collide with each other.

The US Supreme Court ACA decision is likely days or weeks away.  In the words of Bananarama, it could be a “Cruel, Cruel Summer” if you work in a WC claims department.

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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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