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Study: Medical care often costs more under workers’ compensation

When Connecticut workers are injured on the job, they can apply for workers’ compensation benefits to help them with medical expenses, lost wages and some of the other costs that come with injury. Still, workers’ compensation benefits generally come in predetermined amounts, and those amounts may turn out to be insufficient to cover all the injured workers’ needs during recovery and recuperation.

One recent study hinted at a problem that underlies many cases where the benefits going to injured workers are insufficient. The Workers Compensation Research Institute looked at medical bills and workers’ compensation benefits from 16 states in the year 2008 and found that medical procedures often cost more when workers’ compensation benefits are paying for them.

The 16 states together account for about 60 percent of the workers’ compensation benefits paid each year in the United States. Connecticut was not included. In most of the states, the amount paid to health care providers for certain procedures is regulated by the government. In five of the states, the amount is unregulated, meaning that the amount paid was negotiated by workers’ compensation insurers and health care providers. In these states, the cost of procedures covered by workers’ compensation was especially high. Some health care providers in these states charged more than twice as much for the same procedures when they were paid for by workers’ compensation as when they were paid by private insurers.

Connecticut’s workers’ compensation system can have different problems. Often, employers can decide what doctors their employees will see. As a result, the medical providers are somewhat beholden to the employers, and may even work primarily for the employer’s interest. Injured workers sometimes get sent back to work before they’re ready, and sometimes don’t get all the treatment they need. It’s important for workers to understand how to make their claims under the system and how to go about receiving the benefits they deserve.

Source: South Bend Tribune, “Study: Procedures often cost more under workers’ comp,” Richard Newman, July 1, 2013

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Verdicts & Settlements

36-year-old laborer for landscaping company fractured wrist when fellow employee hit him with truck. Claimant received in excess of $30,000 in workers’ compensation benefits for total disability and medical expenses and settled with automobile insurance company for fellow employee for $95,000.

1989 workers’ compensation claim settled for $125,000. Claimant originally sustained a low back injury when she slipped and fell at local grocery store resulting in low back surgery in 1989. Several years later, claimant exacerbated her low back injury. Claim was reopened and settled with carrier for $125,000 in 2006.

47-year-old deli clerk sustained low back injuries at work for local supermarket. Carrier originally denied claim on the grounds that the injury was pre-existing. After formal workers’ compensation hearing carrier accepted claim and paid all total disability benefits and medical expenses in excess of $100,000. Case then settled for an additional $100,000 after injured person received a permanent disability rating.

34-year-old male roofer sustained multiple injuries to his shoulder, neck, back and hip when he fell from roof during work. Claimant was provided workers’ compensation benefits in excess of $100,000 and settled remaining claims for an additional $55,000.

40-year-old male working for cleaning company sustained neck and low back injuries when he fell on defective staircase while cleaning local museum. Claimant recovered over $95,000 in workers’ compensation benefits and resolved claim against museum for $85,000.

26-year-old laborer sustained fractured foot when a cast iron pipe was dropped on his foot. Employer and workers’ compensation carrier denied claim on basis that injured worker was an independent contractor. After a series of informal and formal workers’ compensation hearings, carrier conceded that claimant was an employee and settled case for $85,000.

24-year-old waitress sustained back injury while working at Outback Steak House. Workers’ compensation insurance company initially denied the claim. After a series of informal hearings, carrier accepted claim paying medical expenses and total disability benefits. In addition to those benefits paid, claim settled for an additional $75,000.

Delivery truck driver sustained right wrist fracture in rear-end motor vehicle accident while in the course of his employment. Claimant recovered in excess of $40,000 in workers’ compensation benefits for medical expenses and total disability benefits. Claimant settled case against at-fault driver for $105,000.

22-year-old male working as stocking clerk at “big box” retailer sustained herniated disc in low back. Workers’ compensation carrier refused to accept the claim. After formal workers’ compensation, hearing commissioner ordered carrier to pay over $35,000 in past total disability benefits and pay for surgery and all related medical expenses. Case settled for an additional $35,000 for a total recovery in excess of $100,000.

Rear-end collision on entrance ramp to Merritt Parkway resulting in 49-year-old woman sustaining mid-back injury. Case settled at mediation after filing suit for $300,000.

28-year-old passenger sustained multiple herniated discs in automobile accident in New York state. New York no-fault carrier paid for extended period of disability from work and medical expenses, including expenses for surgery. Case settled against driver of vehicle for $300,000 policy limits shortly after filing suit.

54-year-old man sustains shoulder injury when hit from behind by uninsured motorist on New Jersey Turnpike. Case settled for $135,000 prior to trial.

CT Transit bus driver sustained torn meniscus in collision with another vehicle. Claims made against at-fault driver, workers’ compensation carrier and client’s underinsured motorist policy. All claims settle for a recovery in excess of $100,000.

68-year-old woman sustained neck and back injuries in rear-end collision and required extended course physical therapy, but was not a surgical candidate. Case settled for $100,000 prior to filing suit.

34-year-old woman sustained concussion and neck and back injuries in hit-and-run accident on a New York highway. Claimant settled uninsured motorist claim for her $100,000 policy limits.

80-year-old woman sustained right foot fracture when her foot was run over in a parking lot. Case settled for at-fault driver’s policy limit of $100,000 prior to filing suit.

38-year-old nanny sustained right femur fracture when she fell down defective stairs in home of her employer’s neighbor. All medical expenses and lost wages reimbursed and case settled for an additional $150,000.

Claim against landlord for defective staircase in multi-family rental house. Claimant sustained a right femur fracture. Case settled for $125,000 prior to filing suit.

$95,000 judgment obtained against bar and nightclub for assault by one of its patrons against another patron.

47-year-old woman sustained a broken left wrist when she fell from porch stairs at house she was renting. Case settled for $95,000 shortly before trial.

26-year-old male bitten on leg by German shepherd. Claim against dog owner settled for $65,000 plus payment of all medical expenses.