Tag Archives: cost shifting

Figuring Out Your Work Comp And Disability Benefits

Your work comp benefits will not increase with the cost of living.

If you are injured on the job, it is important to know what your potential benefits may be so you can limit your spending accordingly. Benefits are based on your average weekly wage over the previous year. The exact calculation is a little more complicated than just that, but the basic rule of thumb is that benefits are two-thirds of that weekly wage, but there is a cap. For example, if you made $75,000 a year in North Carolina, your weekly wage would be $1,442.31 a week. Two-thirds of that amount would be $961.59.

Can you get that amount in disability benefits while you are out of work? Not in this state.  If your injury was in 2010, the maximum amount was capped at $834.00 ($43,368 a year) which would be a net loss of $608.31 a week ($31,632.12 a year) from your pre-injury weekly wage, and $127.59 less than two-thirds of your pre-injury wage. It’s hard to pay the mortgage when you suffer a wage loss of over $31,000 a year, and get disability benefits that pay closer to 58% instead of 66%.

In many other states the capped weekly amount is much lower than in North Carolina. For example, Continue reading

Cost Shifting: The Dirty (not so little) Secret of Workers' Comp

Today’s post comes to us from my colleague Tom Domer of Wisconsin. This is isn’t the first post that has appeared on this blog on unethical and illegal employer practices. In the future, we will continue to cover issues like cost shifting and worker misclassification, which pose ever increasing problems for today’s workers. 

Seasoned workers’ compensation practitioners know some employers and worker’s comp carriers consciously employ questionable tactics to limit their exposure. They mischaracterize high risk employee job titles as low risk to reduce premiums; they call long-term employees “Independent Contractors” to get them off worker’s compensation roles; they hire doctors to render boilerplate predictable opinions to deny claims; and they discourage genuine worker’s comp claims by telling employees to submit work-related medical bills to group insurers, Medicare or Medicaid.

They discourage genuine workers’ comp claims by telling employees to submit work-related medical bills to group insurers, Medicare or Medicaid.

This last piece of fraud is extremely nefarious, especially since medical costs now exceed indemnity payments in Wisconsin and most other states. The cost shifting means we all pay (as increased group health premiums and taxes) for medical expenses that should be paid by worker’s comp carriers. In states such as Wisconsin where work injury related treatment expenses are paid at doctors’ usual and customary rates, shifting the cost to a group carrier, Medicare or Medicaid saves worker’s comp carriers millions.

The cost shifting means we all pay (as increased group health premiums and taxes) for medical expenses that should be paid by workers’ comp carriers.

Denial of a claim by using “legitimate doubt” or purchasing the opinion of an adverse medical examiner results in medical treatment provided at reduced negotiated rates through non-workers’ comp coverage (Union health care, Medicare, Medicaid, etc.). Continue reading