The relationship between short-term disability coverage and workers’ comp claims

March 12, 2020 | By Katie Kuehner-Hebert – BenefitsPro

High-deductible health plans have caused workers’ comp claims to spike, but accident and disability coverage can help even things out.

Employers that offer accident or short-term disability insurance to their workers might derive another benefit: a drop in fraudulent workers’ comp claims on injuries actually sustained outside the job because employees couldn’t afford the out-of-pocket costs, according to Guardian Life’s report, “Risk Redirect: Using Group Accident and Disability Insurance to Reduce Illegitimate Workers’ Compensation Claims.

Nearly half (46 percent) of the 1,500 employee benefits decision-makers surveyed by Guardian report a decline in workers’ compensation claims after offering accident or short term disability insurance. More and more employers are offering accident and/or disability insurance plans to help offset out-of-pocket costs and bridge gaps in high-deductible health plans – which also can deter workers from reporting an off-the-job injury as a workers’ comp claim in order to avoid paying for hospital or doctor bills, according to the report.

“Employers offering high deductible health plans are more likely to have experienced an unexpected increase in questionable workers’ comp claims,” Guardian writes. “They attribute at least part of their increase in illegitimate claims to workers misrepresenting off-the-job injuries or illnesses as work-related.”

Indeed, nearly one in five employers with an HDHP report an increase in illegitimate workers’ comp claims since 2017—almost three times as many as those without an HDHP, according to the report.

“Employers offering only high deductible medical coverage are even more likely to report increased workers’ comp abuse,” Guardian writes. “Larger organizations, which are more likely to offer HDHPs, are also more likely to report increased workers’ comp abuse in the past two years.”

Group accident and disability insurance plans help reduce questionable workers’ compensation claims–42 percent of employers report declines of 50 percent or more, while another 22 percent cite declines of 25 percent to 49 percent.

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