Insight, analysis & opinion from Joe Paduda

< Back to Home


Workers’ comp > all other healthcare payers. Period.

and here’s why.

Work comp payers actually care about the patients recovery, return to functionality, ability, and productivity. Work comp HAS to…screwing up recovery = huge financial penalties in the form of claims that last forever, really costly settlements, and migraine-level headaches for all involved.

Whereas in group/individual health, Medicare and Medicaid (mostly), functionality is – at best, and then only rarely – an afterthought.

side note – if you think about it, how dumb is it that 99% of healthcare payers don’t really care whether the $4.2 trillion they spend on healthcare actually improves lives, helps patients stay active, supports functionality, and helps us live the lives we want to live?

answer – dumb as a box of rocks

WCRI’s latest in a never-ending stream of excellent research brought me back to this...researchers examined patient-reported functional outcomes after low-back pain, a far-too-common and sometimes really problematic diagnosis. [report is free to WCRI members and a nominal cost to non-members].

The research compared WC outcomes to those of other payers…and:

  • included patients covered by all types of payers,
  • totaled some 2.4 million patients (!),
  • covered almost 1.3 million PT/OT episodes of care, and
  • used patient-reported functional status specific to the low back pain issue (as captured by FOTO).

The researchers obviously put a LOT of thought into selecting the measure…they describe the process and rationale in detail in the report (ppg. 15 – 19).

credit WCRI

While it is important indeed to consider that workers’ comp patients’ reported functional improvements were not as high as some other payers – and we  need to understand why – that’s secondary to the fact that work comp’s primary focus – return to functionality – is way different from other payers’.

With extremely rare exceptions, no other payers focus on functionality, and almost none do across all patients with all conditions.

Kudos to Sebastian Negrusa, Vennela Thumula, Randall Lea, and Te-Chun Liu for their excellent work.

What does this mean for you?

Work comp gets beat up a lot…this is why – in one extremely important way -workers’ comp is superior to all other payers. 

4 thoughts on “Workers’ comp > all other healthcare payers. Period.”

  1. Excellent observations here! In my opinion, other payers don’t worry about functionality because they don’t have to. WC strives to get the injured worker back “into the game”. As cynical as it sounds, I am convinced that other payers are driven by other motivators.

  2. In a rational world, workers compensation would be the purest form of genuine healthcare because the employer’s heart is in the right place….next to their wallets. Unfortunately, the rewards of disability, malingering, and on-going salary payments are incentivised in workers compensation, not health.

    1. thanks for the note Thomas

      In my experience the instances of malingering and other undesirable behavior are relatively few and far between. Not sure I get the connection between the inference that employers’ hearts are motivated by dollars and employees are motivated to do the wrong thing.

      be well


Comments are closed.

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.



© Joe Paduda 2024. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.