Is it a health insurance claim or a workers compensation claim?
Source: CFO Daily Alert
The CFO Daily Alert reports that for some common ailments, like soft-tissue back, knee, or shoulder pain, it’s often not clear whether the injury was work-related or non-occupational. Physicians are given a degree of discretion under workers’ compensation law to make that determination, which creates a conflict of interest, because they usually end up benefiting financially by classifying the injury as work-related. An ongoing shift to the “capitation” model for reimbursing medical providers leads them to classify more injuries as work-related.
This is because workers’ compensation reimbursement rates are established by law, and they are almost always at higher rates than rates contracted with insurers or self-insured employers.
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