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WCRI – Blogging Live – Do Fee Schedules = WC Case Shifting?


WCRI – Blogging Live – Case Shifting and Fee Schedules

WCRI WC Case Shifting and do fee schedules.

Preliminary Findings

Dr. Osleya Formenko – Author – Impressive- Received Her Doctorate From Our HQ City  Raleigh – UNC

Dr John Gruber- Dartmouth Institute

Dr. John Ruser – Presenter

Picture Of Doctor Case Shifting Writing In Patient Chart

There are many numerous articles on this blog concerning fee schedules

Workers Compensation usually pays more than Health.

Expect that claims shifting is more likely in the states that have higher WC rates than health.

Workers Comp is fee for service – more lucrative

The treating Dr. makes the work-relatedness call

Fractures lacerations contusions are obvious work relatedness

Back strain, knee strain, soft tissue

Dr. Gruber and Dr. Formenyko found that 20% increase in treatment prices  = 6% increase in WC claims vs health

The research indicated that there is a much larger cost factor than may be realized by the 6% when specific states are analyzed such as  Texas and Illinois.

The claims shifting for soft tissue injuries have more of an impact of case shifting to costs that are borne by employers in that state.

There will be further studies performed in the future to see if the number of WC cases / case shifting occurs in states that have a higher variability between health insurance and WC  rates ICD 10 codes, etc.

A great question- Some physicians have said that WC pays less than health insurance, research and data said WC pays more.

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management 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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