This is my angle on workers' comp emergency rooms as initial medical treatment providers. I am not discouraging anyone to not go to an emergency room. What I am covering is minor injury treatment through emergency rooms. Read on to see how I discovered a massive cost-cutting method for workers' comp claims.

James Moore

I have been admonished over the years for recommending a risk management technique that put injured employees’ lives in danger.   Bottom Line – if the injury needs emergency treatment, then go to the nearest hospital emergency room.

My own ER visit = idea

More than a few years ago, I was working a claims adjuster’s desk when I realized something amazing  A huge homebuilder (now defunct) was trying to figure out how to cut workers' comp costs to a minimum while providing proper care for its injured workers. I had just visited an emergency room the week before due to massive cuts to multiple fingers from a canned ham accident.

When the bill arrived, and then the health insurance carrier’s explanation of benefits, I was astounded at the charges. I was covered by an HMO, so the final amount I paid was much less than the original bill. Whew!

I did not have a primary care provider or a family physician. The only place to go that I could get in for an appointment was the emergency room at the nearest hospital. There were no urgent care providers/walk-in clinics in the area.

I then reviewed a loss run for the huge homebuilder to see what factors would help reduce its costs. I noticed that all the injured employees, even with a splinter, went to the nearest hospital emergency room. The light bulb came on that minor claims could be handled by the nearest walk-in clinic at a much-reduced cost. This was before the advent of workers' comp medical networks. Workers' comp emergency room visits were reduced by the builder. Its premiums for workers' comp dropped 30%.

That light bulb was the beginning of the Six Keys to Workers' Comp Savings.

1999 study

I was the director of risk management for the North Carolina School Boards Association when I noticed the cost for certain school districts was much higher per claim than some of the others. I decided to pen and paper analyze more than 7,000 claims to see if the four keys that I had discovered 10 years earlier would cut workers' comp costs (quick injury reporting, medical treatment network in place, return-to-work program, treatment of an injured employee by the school district post-injury).

The most significant cost factor was not having a medical treatment network in place or just telling the injured employee to go to the emergency room or family physician. Even more extreme costs were generated by a minor injury being treated by an emergency room.

New study on workers' comp ER use

A new study was performed by the Workers Compensation Research Institute that carries on the same question. According to the study and report:

Oftentimes workers resort to emergency departments (EDs) to receive their initial medical services after a work-related injury. For some injuries, workers may be more likely to use ED services rather than going to physician offices or urgent care clinics — which are less costly alternatives to ED services.

I have not read the report yet, only an abstract summary. I rarely make purchase recommendations, but in this instance, the $35 may be worth it. 

The other variable that I did not cover in this article is how COVID-19 affected medical treatment.

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.