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Do Zero-Cost Workers' Compensation Medical Claims Really Have Zero Costs? The Impact of Workplace Injury on Group Health Insurance Utilization and Costs

Asfaw, Abay PhD; Rosa, Roger PhD; Mao, Rebecca MPH

Journal of Occupational & Environmental Medicine: December 2013 - Volume 55 - Issue 12 - p 1394–1400
doi: 10.1097/JOM.0000000000000030
Original Articles

Objective: Previous research suggests that non–workers' compensation (WC) insurance systems, such as group health insurance (GHI), Medicare, or Medicaid, at least partially cover work-related injury and illness costs. This study further examined GHI utilization and costs.

Methods: Using two-part model, we compared those outcomes immediately after injuries for which accepted WC medical claims made zero or positive medical payments.

Results: Controlling for pre-injury GHI utilization and costs and other covariates, our results indicated that post-injury GHI utilization and costs increased regardless of whether a WC medical claim was zero or positive. The increases were highest for zero-cost WC medical claims.

Conclusion: Our national estimates showed that zero-cost WC medical claims alone could cost the GHI $212 million per year.

From the Office of the Director, Centers for Disease Control and Prevention–National Institute for Occupational Safety and Health, Washington, DC.

Address correspondence to: Abay Asfaw, PhD, Office of the Director, Centers for Disease Control and Prevention–National Institute for Occupational Safety and Health, 395 E St, SW, Washington, DC 20201 (hqp0@cdc.gov).

The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health.

Authors Asfaw, Rosa, and Mao have no relationships/conditions/circumstances that present potential conflict of interest.

The JOEM editorial board and planners have no financial interest related to this research.

Copyright © 2013 by the American College of Occupational and Environmental Medicine