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Oklahoma Federal Health Insurance Exchange Increase= Case Shifting

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Oklahoma Federal Health Insurance Exchange vs Case Shifting 

The Oklahoma Federal Health Insurance Exchange has basically reported that many health policies in the state will increase by up to 34%.  Reading that headline reminded me of the case shifting that was forecasted by Dr. Richard Victor (WCRI Director) at the 2015 WCRI Conference.   This earlier CutCompCosts article was from a live blog during that conference.

HealthCare.gov Oklahoma Federal Health Insurance Exchange emblem from web
(c) healthcare.gov

Case shifting may occur if the injured employee decides to report what was otherwise a health claim as a Workers Comp claim.   Oklahoma may be a great proving ground for the case shifting theory.  

A follow-up article on the Cutcompcosts blog did indicate the occurrences of case shifting were very likely occurring.

According to the Exchange article

“Statewide, the average benchmark premium (second-lowest-cost-Silver plan) in the Oklahoma federal health insurance exchange will be 35.7 percent more expensive in 2016 than it was in 2015. This is the sharpest increase in any of the 37 states that used Healthcare.gov in 2015.”

Oklahoma will likely be a state to watch to see if case shifting occurs where the price of health insurance becomes much more expensive in just one year.   The other variable that may affect the case shifting could possibly be a serious downturn in an oil-based economy due to lower imported oil prices.

I will return back this article or refer to it in a follow-up article later this year or early next year.  Update – a followup study was not generated by WCRI or the State of Oklahoma on case shifting.  

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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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