Workers Comp Zone


photoAfter years of doing workers’ comp, I must say that it is rare to have an injured worker  client ask what medical treatment costs.

Perhaps that is just human nature, since when someone else is paying the bill we tend to feel free of concerns about whether we can pay.

Since workers’ comp in California is supposed to pay for treatment to cure or relieve the injury, workers generally are not stuck with the bill. Even when treatments are provided in a disputed situation they are generally done on a lien by providers, so the injured worker is rarely liable.

Some workers in disputed injury situations may end up “self procuring” treatment, but those providers may end up pursuing liens, although the rules have tightened considerably on liens in the past few years.

It is rare to see a worker who has actually paid large sums out of pocket.

The situation is often flipped, however, when the worker settles a case via a compromise and release agreement, giving up the right to claim future medical costs at the insurer expense.

Some workers who settle their comp cases are back to work and will get medical through their employment.

Some may settle and get coverage through Covered California coverage. As of 2014 providers under Covered California may no longer refuse treatment for preexisting conditions, which would appear to include pre-existing industrial conditions. Whether this continues to be the case may depend upon further legislative and regulatory changes to Obamacare. What is now the rule may not be the case in the future.

And  workers covered by Medi-Caid/Medi-Cal may have trouble getting treatments for industrial injuries covered.

Workers covered by Medicare may need to show Medicare that the worker and insurer have considered Medicare’s interests by allocating part of the settlement monies for the worker to use on work-related treatments.

Eventually, some workers who settle medical may find themselves without health insurance that will readily cover industrially-casued injury treatments.

Those workers may suddenly become very interested in what treatments cost.

Generally, workers have no idea.

If they are likely to undergo a surgery or medical procedure, I encourage them price it out from their doctor. If they are taking medication, I encourage them to speak with the pharmacy to find what the meds would cost if they had to pay themselves.

This is an eye opener for some clients.

Human behavior being what it is, some clients will trim back on the medications and the procedures if they have to use their own settlement monies. Other incentives enter the picture, namely what they can alternatively do with the settlement money, how they view the effectiveness of the treatment, how much confidence they have in their doctor, etc etc.

it’s called skin in the game.

But some workers do settle and will need to fund treatments for years on end out of their settlement monies.

How can they get more information about treatment costs?

That was the topic of a recent forum of San Francisco public radio station KQED. The segment is called “PriceCheck Investigates the Cost of a Back MRI”. The guests interviewed by KQED’s Joshua Johnson were Jeanne Pinder, founder and CEO of, which joined KQED and Southern California Public Radio to create PriceCheck and Lisa Aliferis, editor of KQED’s State of Health blog.

The discussion highlights the reality of modern medicine. Prices for similar procedures vary greatly, depending on a number of factors. Workers who settle their cases could research the cost of tests and treatments and save themselves large amounts of money.

Here is a link to the KQED show:

PriceCheck Investigates the Cost of a Back MRI

Julius Young