New Study Shows that Workers Comp in Wisconsin Pays More for Medical Services

A comparison of patients on a group health plan and using Wisconsin’s workers comp to treat injuries showed that the state’s workers comp paid more for health care than private insurance.

The margin was not small, either. One price quote found that Wisconsin surgeons, performing the same arthroscopic knee surgery, collected $1,573 from group private insurance, and $3,728 from the state’s workers comp.

The study has prompted several Wisconsin lawmakers to discuss changes to the workers comp system, and speculate on how much employers should be charged for the coverage.

Wisconsin’s workers comp system was one of the first in the nation – adopted in 1911 – and is reportedly one of the best in the country. Injured workers have access to high-quality health care to help treat their injuries, which means they can report to work sooner, which actually keeps costs low. The average time patients use Wisconsin’s workers comp is 60 days, which is the shortest duration of all other states, and half the national average, according to recent data from the National Council on Compensation Insurance.

Despite the national success of Wisconsin’s workers comp system, this year Republican lawmakers are looking into the system in order to make the state more business-friendly.

“I’m not saying anything is broken,” said Rep. Dan Knodl, R-Germantown. “There will be some positive reform that labor and management are going to be happy with and will strengthen an already good system.”

Wisconsin requires almost all businesses to buy private workers comp insurance, or self-insure, and has regulations that encourage employers to bring workers back and employees to return quickly. Employers pay higher rates as penalty if employees don’t return near their previous salary, and weekly cash benefits through the system are low enough that employees prefer returning to work as soon as possible. This has helped keep costs down compared to other workers comp systems.

Benefits for workers include the ability to see the medical provider of their choice, and if the injury causes a long-term disability, the provider rates the severity and the insurance company provides a regular workers comp payment. Disagreements about the severity are resolved by a division in the state Department of Workforce Development, so that employers, disabled employees, and the state are satisfied with the monetary involvement. Wisconsin’s workers comp litigation is the lowest in the nation, at 3.7%, and workers comp premiums to employers have stayed relatively stable, with annual increases at about 0.1%.

The system works well – employees have the highest satisfaction with workers comp, according to health care studies – so it is unclear why changes should be made, said Mark Grapentine, a nonvoting representative for the Wisconsin Medical Society on the advisory council.

“When you talk with other states and other states’ workers’ comp systems, it is generally an albatross on their health care world,” Grapentine said. “Whereas in Wisconsin it’s held up as providing some of the best health care in the country that can be touted as a reason to do business in Wisconsin.”

Reportedly, however, medical costs have risen faster in Wisconsin than in states with similar systems. The median increase among 16 states between 2006 and 2011 was 5.8%, while in Wisconsin, the increase for the same period was 8.6%.

Regardless, workers comp premiums remain stable.

“Clearly this has become a provider compensation program,” said Andy Franken, president of the Wisconsin Insurance Alliance. “Seventy cents out of every claim dollar goes to providers and not to workers.”

“What we would like to see is more money going into workers’ pockets,” said Stephanie Bloomingdale, secretary-treasurer of the Wisconsin AFL-CIO. “For short-term and long-term disability those amounts have been stagnant for a long time, while more and more of the dollar is going to health care cost.”

The Strom Law Firm Understands Worker’s Comp Legislation

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.