Summer workers compensation claims

Summer + Softball Season = Workers' Comp Claims!

It's summer and it's softball season. One of your employees is playing and hits the ball to left field. In an effort to stretch the hit into a double, he messes his ankle up while sliding to the base. That night he ices it and hopes for the best in the morning.

Morning comes and he knows that something more serious is wrong. He should go to the doctor or urgent care but with his high deductible health plan, he doesn’t want to incur the expense.

He goes to work and claims the injury happened there!

How Are the Two Related?

High-deductible health plans are a way of life for many Americans. In 2019, HSA-qualified health plan premiums averaged 13% lower than traditional PPO options[1], and 52% of employers offered at least one high deductible health plan.[2]

The Workers Compensation Research Institute found that workers on HDHP’s have a greater likelihood of reporting off-the-job injuries as workers’ compensation claims. While they report a downward trend in overall claims frequency, claimant fraud has been on the rise the past few years in certain workforce segments. Industries more likely to see an increase in fraudulent claims include, but are not limited to government, hospitality, healthcare, social services, and construction.

One Solution to the Problem

The addition of accident and disability insurance, either on an employer or employee pay basis, is one solution. According to Guardian Life’s seventh annual Workplace Benefits Study, 46% of employers reported a decline in workers’ compensation claims after offering accident or short–term disability insurance.

This strategy is one for employers to consider when trying to quell questionable workers’ compensation claims and reduce the impact of lost workers’ compensation claim dollars and higher future premiums.

What should an employer be thinking about?

Accident insurance to help pay medical expenses. Regardless of who pays for the premium, accident insurance can help the employee fill some of the medical gaps created by a high deductible plan.

In the event of an accident, it pays a lump sum cash benefit to offset medical expenses. This cash can help keep the cost of medical care on the medical side of the ledger instead of the workers’ comp side.

Short-term disability insurance. Guardian’s research found that employees with disability insurance overwhelmingly purchase it through their employer. This protection replaces a portion of an employee’s income if they are sick or hurt and cannot work due to a covered accident or sickness.

Education. To help make this all work, employee education is important. The employee must understand the benefits they have, when they will pay, and how much it will pay. Through education, the employee has reduced financial stress and anxiety. This in turn allows managers and HR departments to quickly address questionable workers’ comp claims, control costs, and recruit hard-to-find talent.

In summary, employers are facing many challenges. Whether it’s reducing workers’ comp claims, recruiting talent, or keeping down costs. The accident and short term disability plans, along with education can be part of the solution.

What happened to our weekend softball player?summer workers compensation claims

The employee managed to make it to his work station where he let out a yelp and held his ankle. What he didn’t understand was his ankle had swollen to the point where they had to cut his laces to get his boot off. Once his boot was off, the bruising that had started to show, and it was more than enough for his supervisor to figure out it hadn’t just happened! In this case Claim Denied!

[1] Seventh Annual Guardian Workplace Benefits Study


Workers Compensation Planning

Tim Pachowitz helps businesses build, communicate and implement employee benefit plans. As an Account Executive at Benefits, Inc. engineering a plan strategy from start to finish is the most rewarding part of the role. Outside the office, Tim enjoys fishing, hiking, and making maple syrup. Most of all, he enjoys time outdoors with his 6 grandsons (no girls yet).