There has been much debate as to whether The Patient Protection And Affordable Care Act will actually reduce or increase workers comp costs. Some are saying that employees without health insurance have been filing workers comp claims to get medical treatment but now that they will have their own health coverage, the number of fraudulent workers comp claims will fall. Also, employees will get better workers comp care. As the additional 32 million people in this country obtain health insurance, the availability of primary care physicians decreases due to higher demands and workers comp cases will see specialized occupational health physicians who are better suited to treat workers comp injuries.

I believe these optimists are missing the fundamental reason as to why these people are filing workers comp claims in the first place. In my experience, when these people file workers compensation claims, it's not always about medical care, but about the employee getting benefits (indemnity payments) and settlements while giving employees tax-free dollars while staying out of work. Furthermore, As health insurance carriers experience a dramatic increase in claims, they will need to question whether or not these new claims are work-related. As they send out their questioneers, make phone calls, and do their other investigative work, once again employees will have to balance the payments they receive on short-term disability for 6 months versus workers comp payments and settlements that can last for years or for life. The other distorted notion that employees will get better care while treating with occupational doctors or doctors that understand disability and impairment ratings better under workers comp is very false because there aren't that many occupational medicine doctors relative to the amount of regular treating physicians in the country and most doctors that are treating workers comp have no idea about disability and impairment ratings. These are usually left for independent medical exams.

In conclusion, while I do believe that most people are legitimately injured and we are all thankful for the workers comp system to help them out, there are still those that abuse the system. They didn't just abuse the system to get medical treatment in the past. They abused the system and will continue to do so in order to get workers compensation indemnity benefits in the future.

The bottom line is that the complex nature of workers compensation claims makes insurnace carriers susceptible to errors that lead to overcharges in your workers compenstion premiums. Healthcare reform will only make the workers comp claims environment even more confusing, giving even more reason to have an independent workers compensation audit.