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High Health Insurance Deductibles Cause Case Shifting – WCRI Study


Larger Health Insurance Deductibles Cause Employees To Use Workers Comp

The health insurance deductibles have been raised over the past few years.  One reason could be the Obamacare Federal and State Insurance Exchange insurance carriers wish to negate the effect of having to insure all-comers with pre-existing conditions.

health insurance deductible
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A recent study by WCRI (Workers Compensation Research Institute) showed that higher health insurance deductibles led to case shifting.  WCRI has covered case shifting before in various studies and their annual conference.

Case shifting occurs when an injured employee looks to lessen their risk by shifting an injury from one line of insurance (usually health) to workers compensation.

The recent study results from WCRI on health insurance deductibles and case shifting recent press release covered a few salient points.

The following is a sample of the study’s major findings:>>>my comments in italics

  • Workers with a higher remaining group health deductible at the time of injury are more likely to file under workers’ compensation than under group health insurance.>>>This should be seen as not really a surprise.  
  • Injured workers are about 1.4 percentage points more likely to file a workers’ compensation claim when they have a remaining deductible of $550 (the average) compared with a zero deductible at the time of injury, amounting to a 5.3 percent increase in the workers’ compensation claim volume.>>>A deductible of $550 seems low nowadays
  • The increase in propensity to file for workers’ compensation coverage in response to higher deductibles is even greater for injured workers with soft tissue conditions.>>>This is a very interesting finding.
  • The increase in filing for workers’ compensation coverage is concentrated in states where employees can choose their initial provider. This may reflect the ability within workers’ compensation of workers to remain with their group health doctor in these states.>>>This makes sense.  I totally agree with that assessment. 

The study also estimated the increase in workers’ compensation volume from the growth in high deductible group health policies. The increase partially offsets the overall decline in workers’ compensation claims seen over the past decade.

You can found out more information on the study and purchase a copy here.   A video from one of the authors explaining the study further is also included on the page.

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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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