Obamacare may lead to more soft tissue workers’ comp claims in Colorado

A recent study finds that soft tissue conditions approved for workers' comp coverage may increase by almost a third due to Obamacare.

The passage of Obamacare has led to many changes, including an increase in the use of flat-fee health plans. These plans allow health care providers to receive a set amount of compensation for each patient, regardless of the type of care provided. This is in contrast to the fee-for-service system, which compensates physicians based on the "individual service rendered."

A recent study by the Workers Compensation Research Institute (WCRI) states that the increase in flat-fee plans will likely translate to a shift in claims from group health providers to workers' compensation claims. An article in Business Insurance discussed the study, noting the change will most likely result in an increase in the number of soft tissue conditions considered work-related injuries and thus qualifying for workers' compensation coverage.

More on the study

The study reviewed data from a large commercial database. The authors of the study note that the data reviewed was unique as it included information on both the group health plans and workers' compensation coverage received for each participant.

Researchers with the study found that back injuries were 20 percent more likely to be classified as work-related and paid by workers' compensation providers if the patient's group health insurance was a flat-fee, or capitated, plan as opposed to a fee-for-service plan. Similarly, states with a high number of workers covered by capitated group health plans also experienced a 31 percent increase in the number of soft tissue injuries classified as work-related.

Soft tissue injuries and Colorado Workers' Compensation

The Colorado Secretary of State's Division of Workers' Compensation states that qualifying soft tissue injuries are covered by workers' compensation in the state. As a result, those who suffer from soft tissue injuries while working in Colorado may have a greater chance of receiving approval for a workers' compensation claim depending on the details of their health insurance plans.

Regardless of these details, it is beneficial to have a basic understanding of how the system works. The Division defines soft tissue injuries as "traumatic injuries to the muscles, ligaments, tendons, and/or connective tissue." The most common example of soft tissue injuries are neck injuries like whiplash. These injuries are generally classified as follows:

  • Grade I. Stiffness and tenderness of the neck.
  • Grade II. Stiffness and tenderness of the neck that include limited range-of-motion.
  • Grade III. Stiffness and tenderness of the neck with limited range-of-motion and neurologic signs.
  • Grade IV. Neck injuries that include a fracture or dislocation.

This discussion provides an example of the complexity of workers' compensation claims. As a result, it is wise for those who are injured on-the-job to seek the counsel of an experienced workers' compensation lawyer to help better ensure you receive the benefits you are entitled.