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WCRI – Does the “Grand Bargain” exist? Should it continue to?

WCRI CEO John Ruser PhD led the final panel discussing the status and future of workers’ comp as the Grand Bargain between employees and employers.

Bruce Wood and Emily Spieler PhD sparred over who pays for workers’ comp and tort issues in workers’ comp, specifically negligence and the burden of proof.  Spieler suggested we need to consider costs, how those costs are distributed, and who pays those costs.

David Deitz MD PhD jumped into causation, noting this was a “particularly thorny issue in the 21st century.”  Home-based employment, diseases of life, and other factors make it very difficult indeed to establish who is “responsible” for 50% of the cause of an injury.  The issue – people need care, and we should be talking about how to get them the best care and not argue about who pays.

Editorial note – That, dear reader, is a critically underappreciated point.  We are fighting over who pays, and we should be focusing on optimal care.

David Michaels PhD discussed the challenges of occupational disease – attribution/causation, long-term loss of wages and compensation therefore, cost shifting to SSDI, and harm caused to undocumented workers. Bruce Wood asserted that the undocumented worker issue was not work comp related, but rather a failure to enforce immigration laws.

Spieler asserted that she doesn’t think WC was ever set up to pay for long-term wage loss, or permanent and total (PTD) disability.  She noted research indicated 20% – 40% of workers who suffered amputations didn’t file work comp claims – even if it was clear it the injury was work related.

Ruser asked Deitz about the level and quality of medical care given to work com patients. Uniformly, it isn’t as good as that delivered under group health. But, he argued that work comp is diverging away from where group health is headed, towards value-based care.  That divergence is highly problematic.  FFS – the ONLY reimbursement system existing in workers comp – rewards doing more to get paid more regardless of quality. That’s inherently in conflict with a drive towards quality which is happening in the real world outside work comp.

Deitz would roll work comp medical into group health if he was convinced anyone injured in the workplace could access care.  As not all employees have coverage, that world does not yet exist.

Michaels argued that we’ve really dropped the ball on injury prevention, especially when compared to Germany where there remains a strong focus on prevention.  I hear that, but given the steady decrease in claim frequency over the past three decades, I’m not sure there’s an economic argument to be made around that level of prevention. Tied to Michaels’ argument is an OSHA prevention program that links safety to profits and financial results.

In contrast Wood opined that most employers invest in safety and loss prevention, leading to a to-and-fro between Wood and Michaels on involving public health officials to intervene with employers who don’t adequately address loss prevention.

My takeaway – a bit too much in the weeds, and not enough discussion of where work comp is going given the dramatic changes occurring in our workforce today and tomorrow. I’d have liked to see a bit more on historical perspective; work comp laws and systems were set up 100 years ago when most work was heavy manual labor leading to trauma.  Today, it’s diseases of life, of aging, of comorbidities and cumulative trauma, which are inadequately addressed at best.

Thanks to IAIABC’s Jennifer Wolf-Horejsh for asking about the 50+ million workers who are in non-traditional employment arrangements (my words not her’s).  Spieler asked if we need a national non-employment linked disability program to help address this issue going forward.

Kudos to Spieler for noting that wage replacement adequacy is a major problem; Indiana just raised their very-low indemnity payment basis and few in the audience supported that increase in a show of hands.

Jim Hudak of Paradigm addressed this in a very good question summarizing how employment has changed drastically from days of pensions, good health benefits, and life-long careers with the same employer.  Work comp has NOT adapted, as the social safety net has deteriorated. and employment-based benefit system has all but disappeared

2 thoughts on “WCRI – Does the “Grand Bargain” exist? Should it continue to?”

  1. Dr. Deitz is correct. We should be putting comp and general health care in the same silo, and not worry about who pays.

    And if there is not enough adequate care to go around, there are alternatives.

    Yes, comp has to change, and as the Chinese say, a journey of a thousand miles begins with one small step.

  2. It appears Bruce Wood may have been outnumbered on the panel. He brings up good points. Most employers invest heavily in safety now. They understand protecting employees will benefit the company as well as the worker. Lower injury rates increase employee retention, reduce turnover, save on additional training costs and reduce WC Costs. It’s not altruistic, just common sense.

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Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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