Study Shows Workers Comp Hospital Payments Higher Than Group Health


New Study Shows that States Could Save Money on Workers Comp Payments

A new study that surveyed 16 states shows that in half the states shows that hospital outpatient surgeries on shoulders for workers comp injuries were at least 43% – about $2,000 – higher than private insurance payments, ie group health payments.

The study was called Comparing Workers Compensation and Group Health Hospital Outpatient Payments, and is the first study to compare private insurance/group health payments to workers comp. The study compared 16 large states which represent 60% of the workers comp benefits in the US, and compares payments made by workers comp versus payments made by private insurance, or group health, for outpatients surgeries since 2008.

“These are large differences in costs in many states. Policymakers looking to contain medical costs in these states may want to ask if the difference is necessary to induce hospital outpatient departments to treat injured workers,” said Richard Victor, executive director for the Workers Compensation Research Institute (WCRI), which conducted the study.

Not only did the study find that workers comp payments were higher than private insurance payments in half the states, but it also found that, in the states in which there were hospital regulations based on percentage of the charges, or no hospital price regulations at all, workers comp was charged much more than private insurance.

Most states have not had substantial changes to their fee schedule regulations until after 2008 (exceptions being Texas, North Carolina, and Illinois). Therefore, the interstate comparisons should be reasonably accurate.

Workers Comp in South Carolina

Basically, workers comp is an insurance policy your employer must carry to make sure that employees injured at work can obtain necessary medical treatment and financial assistance for lost wages, plus additional compensation for any work-related injury, sickness, or disease that causes total or partial impairment to work. Workers’ compensation is available regardless of fault when the injury arises out of, and in the course of, employment.

By law, every South Carolina employer with four or more full-time employees must have workers comp insurance.

The protection provided under the South Carolina Workers Comp Act is only the beginning of your right to comp for a workplace injury.

Any full-time employee (working for an employer with four or more employees) who has an employment related injury and needs medical attention should be covered under workers’ compensation insurance. It doesn’t matter if the injury was a complete accident or the fault of a co-worker.

The employee MUST notify his or her employer within 90 days of the injury or risk losing the right to benefits under workers compensation. (It is recommended that you record details of your accident and to whom you reported it.)

Migrant and seasonal farm workers are not covered under workers comp insurance.

If it’s been more than 90 days since your work accident occurred, you might need help obtaining benefits for medical treatment and lost wages.

The Strom Law Firm Can Help with Workers Comp Cases

The workers comp lawyers at The Strom Law Firm, LLC proudly seek justice on behalf of employees injured or killed on the job who work for private companies, as well as employees working for local county, city, and state government. We are licensed to practice throughout South Carolina, as well as Georgia and New York. If you are confused about worker’s comp laws, or have had your worker’s comp claim denied, contact us. We offer free consultations to discuss the facts of your case. 803.252.4800