Group Health Deductibles and Workers’ Compensation

At the 2019 WCRI Annual Conference, Dr. Olesya Fomenko, WCRI, discussed their study on how higher deductibles for group health plans may impact workers’ compensation claims activity.

According to a Kaiser Family Foundation study, the average group health plan deductible in 2008 was $765. In 2014 that number was $1217 and by 2017 that number was up to $1505, During that same time, the percentage of workers enrolled in group health plans with deductibles above $1000 increased from under 20% to over 50%.

The major findings of the WCRI study were:

• Patients do respond to cost sharing arrangements on their group health when making decisions about filing a workers’ compensation claim.
• The impact of high deductible plans is much larger on sot tissue claims. This makes sense because with soft tissue injuries the mechanism of injury is not always clear.
• In states where the injured worker had control over choice of medical provider in workers’ compensation, the increase in workers’ compensation filings due to the higher group health deductibles was higher.

• Due to growth in group health deductibles, workers’ compensation claims volume increased by 5% from 2008-2017.
• In worker medical choice states, the increase in workers’ compensation filings due to higher group deductibles was 10%.