Workers’ Comp “Opt-out” Model Could Benefit Employers & Workers
Medical records review is vital for workers’ comp benefit determination. Here we look at how the “opt-out” model could benefit employers and workers.
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Is minimum government intervention in people’s lives a better option? Maybe yes, as the Texas model of workers’ compensation appear to suggest. Workers’ compensation programs in different states exhibit certain flaws that create dissatisfaction and anxiety among workers. While medical records review is vital to determine eligibility for the benefits, there are other considerations as well such as whether the injury/illness is truly work-related. Employer participation in the program is a much discussed topic, and it is this important aspect of workers’ compensation that we are looking at here. The Texas Model Workers’ compensation program is governed by state law, and this protects employees against loss of income and for medical payments related to work-related injuries, or illness. In most US states, workers’ comp coverage is mandatory. Over the years, however, the program started facing various issues with employers experiencing increased costs and employees finding their benefits declining. Flaws have been reported in the program, following which many states have taken steps to fix those flaws and make the system more perfect. Some states have tried to find solutions outside of the government such as allowing employers to find private alternatives. Texas, the Lone Star state is said to have implemented the most successful of those reforms – this success is attributed by some to the fact that it is a state with a thriving private sector work-injury benefit option to state-mandated workers’ comp programs. In Texas, employers can choose to opt into the state system or choose not to. Those choosing to opt out are known as non-subscribers – they can choose to offer their workers a private benefit plan or offer no plan at all. Employees in this model have access to the courts if their injuries/illnesses are not properly handled. According to the Texas Department of Insurance, in 2016, 78% of Texas private-sector employers subscribed to the workers’ compensation system, while less than 5% of employees are not covered by a state or private plan. Employees covered by private plans are reported to have experienced better outcomes such as shorter periods of disability, faster return to work, and lesser claim disputes. Inspired by the Texas model, other states have attempted to follow suit but have faced opposition such as the U.S. Department of Labor launching an investigation of the alternatives to state-managed workers’ compensation. The investigation was spurred by the fact that unsuccessful alternatives could be leading to cost shifting to the federal government as injured workers have to seek medical and other benefits elsewhere. The Texas model was adopted in Oklahoma, Tennessee and South Carolina. However, the Oklahoma Supreme Court struck down the Oklahoma plan, while the U.S. Department of Labor started the investigation on Texas’ nonsubscription plan and also recommending federal control of state workers’ comp systems on a national level.
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Benefits of the Employer “Opt-out” Model The Texas non-subscription model has some perceived benefits: •
In this model, there is more co-operation, trust, and mutual responsibility between employers and their workers.
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Employers are not relieved from their liability for possible negligence as they would be under the state workers’ comp system. This in turn will ensure that employers proactively make the workplace safer to prevent work-related injuries/illnesses to the maximum extent possible.
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Employees can report injuries quickly so that they can receive due medical care early, recover faster, and return to work sooner.
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Employers have to constantly and actively communicate with their employees about the program.
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Employees can make an informed decision whether to join or leave an employer on the basis of the risks inherent in their task, and the conditions of the plan offered.
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The options available for employees act as incentive for employers to ensure the best plan for their workers.
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Employers are free to shop for benefit plans; this in turn will lead to insurance companies competing for employers’ business, which would reduce the prices.
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Insurance companies will strive to offer customized solutions for employers rather than a costly one-size-fits-all solution. When the costs are reduced, employers can focus on better care for injured workers.
As you can see, in a non-subscription system, there is more chance of employers and employees interacting, and far more than in a state-run program. In fact, this model could be a great way to bring improvement to the state systems as well. How? When there is stiff competition to face, government-run systems will take steps to benefit employees as well as employers by improving outcomes and minimizing the burden of the workers’ comp system. Injured workers could face worse outcomes if the government chooses to federalize the control of workers’ compensation systems or choose any other method of putting an end to the Texas option. Reducing governmental intervention, on the other hand, would enhance co-operation between workers and employers.
www.mosmedicalrecordreview.com
(800) 670 2809