Tag Archives: fraudulent employer practices

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