The Truth About the Affordable Care Act and Workers’ Compensation

The Truth About the Affordable Care Act and Workers’ Compensation

Denver Workers Compensation
The Affordable Care Act (ACA) presented changes in healthcare coverage that often became controversial. Knee-jerk reactions from insurance companies and human resources organizations believed the ACA would either reduce care quality in workers’ compensation or encourage fraud.

Independent non-partisan studies showed these fears were unfounded. In fact, the ACA did more to help workers’ compensation claims and reduce fraud. These are the myths often stated about the ACA and workers’ compensation and the truth of these issues.

Myth: The ACA will crowd out Denver workers’ compensation patients as demand for primary care increases.

Truth: Studies show that the increased demand has not affected access and quality of care for workers’ compensation patients.

The ACA increased health insurance coverage which created a run on primary care. Doctors received more patient files and that was expected to decrease the quality of care for those receiving treatment under a workers’ compensation policy.

A comprehensive report by the National Council on Compensation Insurance, Inc. (NCCI), concluded that there was no significant impact to care access. Medicine has always been a demanding field and that did not change with the ACA. Clinics and hospitals adapted to the new demand for primary care. Patients received better treatment overall for all their needs, including any workers’ compensation claims.

The same report showed that 68 percent of primary care services occurred during the first 10 days of a workers’ compensation claim. Basically, these claims start off as being demanding on healthcare providers but eventually taper down to become manageable. That allows the issue to even out across the board as providers adapt to patients’ needs.

Myth: The ACA increases the possibility of workers’ compensation fraud.

Truth: Due to increased access, there are fewer reasons to file a workers’ compensation claim and that will likely reduce fraud.

Workers’ compensation coverage can be a result of cost-shifting. When a worker is underinsured, doctors may classify the injury or illness as a workplace injury. This allows the claim to become a workers’ compensation matter that reduces costs to the worker.

Cost shifting was most common with pre-existing conditions. When insurance companies were allowed to deny coverage for those injuries or illnesses, it created a desperate situation where fraud became preferable to declining treatment.

Now, pre-existing conditions are covered and that reduces the need to classify a condition as a workplace claim to guarantee coverage. Two reports, the NCCI one and another independent study by Cognizant, indicate overall claims and fraud decreased since the passage of the ACA.

Myth: Doctors are more likely to label a condition as a workplace injury because they receive more for reimbursement.

Truth: While the insurance industry feared this development, it never played out.

This is related to the crowding-out concern. As doctors face higher case loads, they may be concerned about being paid for all these patients. ACA policies do not pay out as much as workers’ compensation ones so doctors become more willing to believe fraudulent claims and push for workers’ compensation rather than a routine healthcare claim.

However, this has not played out. Workers’ compensation claims decreased overall with no evidence of fraud becoming more widespread. As stated earlier, workers are not as dependent on the workers’ compensation to receive healthcare. The same incentive for fraudulent claims does not exist anymore.

Myth: The ACA will raise workers’ compensation medical costs.

Truth: The support of preventative care reduces claims and also medical costs.

Cognizant reported that in Massachusetts, workers’ compensation claims reduced by 16.7 percent and workers’ compensation hospital costs decreased between five and 10 percent. The ACA reduced costs from the supply side and that affects all healthcare, even that covered by workers’ compensation. This is especially true in states that adopted a Medicaid expansion and increased coverage to more people.

Preventative care played a role as well. For example, obesity prevention programs reduced workers’ compensation costs by three to four percent.

The areas of workers’ compensation and healthcare are complex and that often leads to misunderstanding and rumors. These myths can lead to uninformed decisions and mishandling of your claim. Contact our Denver Workers’ Compensation Attorneys today to get help with or a review of your Colorado workers’ compensation case.

How Trump May Affect Workers’ Compensation In Colorado

How Trump May Affect Workers’ Compensation In Colorado

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The new Trump administration has ushered in some changes that many Americans weren’t quite prepared for, and much of the impact is not yet fully known. After all, he’s only been in office for a little over four months, and many changes are yet to come. With respect to workers’ compensation (work comp) benefits, the potential effect has not been fully realized. However, it appears that the greatest potential impact will come from the repeal of the Affordable Care Act (ACA) and budget cuts.

Healthcare Reform

In Colorado and many other states, the ACA, more popularly called Obamacare, has generated a favorable trend in work comp claims. Claim rates and costs have been dropping, and this movement is very likely due to increased worker access to healthcare. In its 2016 report, the Upjohn Institute for Employment Research identified a strong correlation between the decreased work comp claims and costs and the uptick in health insurance coverage.

Joe Paduda of Health Strategy Associates delves even deeper into the link between Obamacare and work comp claims. He alleges that workers who are hurt on the job have less reason to pursue care through their employer’s work comp insurance if they have their own health insurance.

Further, other health issues that may impact their work injury can be covered by the worker’s insurance, rather than work comp. For example, an employee with high blood pressure would need additional treatment for his hypertension before he could undergo a necessary work-related surgical procedure. However, when the worker has health insurance, his coverage would bear the additional cost, rather than work comp.

The proposed repeal and replacement efforts of Trump and the Republican-led House has thrown millions into uncertainty with respect to healthcare coverage. The most recent version of the new TrumpCare coverage, the AHCA, has the potential to take away health insurance from 14 million Americans by next year, according to the Congressional Budget Office (CBO) estimates. And the number of insured is expected to continue increasing over the next 9 years.

These dire projections could spell big trouble for work comp. Uninsured workers would likely once again turn to work comp for as much medical coverage as possible. These changes would also disproportionally affect older employees, workers in higher risk jobs and many who currently receive coverage through Medicaid. These issues will equate to increased claims and higher costs.

Budget Cuts and Safety Issues

Trump has also proposed budget cuts and safety reform rollbacks that will have adverse effects on the work comp system. While the Obama administration was moving towards establishing minimum workers’ compensation benefit standards on the state level, the Trump administration has expressed no interest in pursuing these reforms.

Repeal of an Obama-era OSHA safety regulation could have a detrimental impact on injured workers, as well. The “Volks” rule requires dangerous industry employers to keep health and safety incident records for five-and-a-half years. But Congress changed that to just six months, and Trump signed off. This minimum record-keeping requirement may prevent identification of frequent and repeated safety issues with many companies, and make it much more difficult for their employees to obtain work comp benefits when injured.

If a disabled worker is receiving both Social Security Disability Insurance (SSDI) and work comp benefits, the total may not exceed 80 percent of the average earnings that the worker was receiving before he became disabled. It they do, the SSDI benefits are reduced to offset the overage. In 15 states, this works in the reverse. Instead, it is the work comp benefits that are offset. On May 23, Trump released information on his most recent budget plan with proposed cuts. The Workers’ Compensation Reverse Offset faces elimination in 15 states, of which Colorado is one. With this change, work comp will need to make up the shortfall that the government has been covering via SSDI, hence, raising costs.

Overall, it appears that the Trump administration will be bad news for work comp in Colorado, and throughout the nation. And that’s only addressing what we know so far. If you have questions about these pending changes, or other workers’ compensation issues, please contact us for answers.




Kalin: Obamacare has had an impact on workers’ compensation claims in Colorado

AHCA, CBO, and Workers’ Comp

Four Ways the New Administration Will Influence Workers’ Comp

Key Differences Between Workers’ Compensation Benefits and Personal Injury Awards

Key Differences Between Workers’ Compensation Benefits and Personal Injury Awards

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People are often confused about workers’ compensation benefits in Colorado. Many believe that recipients are paid in a manner similar to personal injury lawsuits. Others may understand that there is a statutory standard, but are unaware of the parameters. Let’s try to clear up some of this confusion with an overview on what workers’ compensation pays employees who have been injured in work-related accidents or have fallen ill due to their job duties.

Many of you are aware that personal injury awards can range into the hundreds of thousands of dollars based on the type of injury sustained and the fault of the negligent party. These awards and settlements are often boosted by the careless or negligent behavior of the company that led to the injury. In many cases, the amount of money received is increased due to punitive damages. Workers’ compensation benefits operate quite differently.

Negligence or fault is not a factor in workers’ compensation cases. Instead, these benefits are set up as insurance for instances when your work duties lead to injury or illness. The benefits are meant to replace the work income that you would have normally earned had your injury not prohibited you from working and gaining employment income. Rather than assigning blame and seeking to compensate you for what you have lost and suffered, workers comp pays you a percentage of the wages you have lost due to your injury. This can range from a temporary timeframe to a permanent arrangement based on the unique circumstances of your injury and outcome.

You Won’t Believe These Unusual Workers’ Compensation Cases

In some cases, you may be eligible to receive education or vocational benefits to help you learn a new skill or trade when you are no longer able to perform the job you were doing prior to your injury. And if your injuries are so severe that you can neither return to your previous work nor perform the duties of some other job, then you may be eligible for long term disability payments. These benefits seek to compensate you for the income you will lose out on for the duration of your remaining working days. Experts apply extensive and complicated formulas to determine what this lifelong work income would be. Benefits are then paid out as either a lump sum or periodic payments over time.

These benefits also cover medical bills related to your injury, to include treatment, surgeries, therapy, rehabilitation and some associated costs, such as mileage to and from your medical appointments.

Workers’ Compensation Fee Schedule and Benefit Payments

The Colorado Workers’ Compensation fee schedule is reviewed annually. For the July 1, 2016 through June 30, 2017 time period, the maximum amount you can receive for lost wages is $939.82 per week. This may apply to workers who’s weekly earnings were at least $1,409.73. If you are determined to be disabled and your impairment is 25 percent or less, the maximum lump sum you may receive is $86,697.04. If your impairment is rated at higher than 25 percent, the maximum amount is $173,391.90. This applies to workers who were injured after January 1, 2014. These are the maximums. To determine the specific amount you are eligible to receive, your employer’s workers’ comp carrier determines your average weekly wage and multiples it by 66 and 2/3 percent. There is no minimum weekly benefit.

These formulas are often complicated and confusing. You may also be eligible for scheduled or non-scheduled impairment and/or body disfigurement. Our experienced Denver workers’ compensation lawyers can help you understand these benefits and work to ensure you receive the maximum amount that you are entitled to under law.

Paying Providers More May Help Workers Recover Faster

Paying Providers More May Help Workers Recover Faster

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It’s old news that workers’ compensation systems differ between states. Everything from compensation amounts for missing limbs to the amount of choice workers have for their doctors can be different between Colorado and, for example, New Mexico. That’s why it’s so important for a disabled worker in Denver to seek out a Denver disability attorney or Denver disability lawyer for his or her disability claim.

Recently, some state workers’ compensation systems are increasing the incentive for doctors to see and provide treatment for injured workers in a timely manner. This incentive can manifest in a number of ways, from the dollar amount workers’ compensation systems are willing to pay out to providers to the amount of visits workers are allowed for physical therapy after the primary treatment has occurred. In North Carolina, provider reimbursements will increase in July in an attempt to reduce treatment delays and allow injured workers to recover sooner.

Related: Would’a, Should’a, Could’a Doesn’t Matter When it Comes to Health Insurance

Delaying treatment, as any Denver disability lawyer worth his or her degree will tell you, can often prolong a workers’ compensation claim and force workers to suffer through their injuries while increasing frustration with the entire system. Under the new rule in North Carolina, the largest amount a professional service can be billed for will be between 40 and 95 percent more than current base amounts for Medicare. Before this increase, the fee schedule was based on the reimbursement rates for Medicare outlined in 1995.

This step taking effect in North Carolina and potentially in Arizona is a grand leap forward for insuring workers receive treatment in as timely a manner as possible and helping injured workers get back to work sooner. Other states considering similar increases include Florida, Montana, Indiana, South Carolina, Utah, Virginia, and New Hampshire. Increases in reimbursement for providers is of course not the only factor that influences access to care for injured workers. Choice of provider, especially in rural areas, is an enormous factor, in addition to how familiar given providers are with the mass of paperwork workers’ compensation entails.

Workers’ Compensation can be difficult, confusing, and very complex. Kaplan Morrell has helped thousands of injured workers since 1997 get the benefits they deserve. Contact us here or call us at (866) 356-9898 for your free consultation.


Should Workers’ Compensation For Public Workers Be Expanded?

Should Workers’ Compensation For Public Workers Be Expanded?

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The Workers Compensation Act of Colorado has clearly included public workers as one of those entitled for compensation benefits. This is the same with other States, and includes policemen, fire fighters, and other first-responders. These workers are covered for any ailments or disease that may develop due to the performance of their work.

Should Workers’ Compensation for Public Workers be expanded?

In Connecticut, some legislators have pushed for the passing of a bill that would provide coverage for post-traumatic stress disorder. This would be for first responders who witnessed the death of another person or people in violent ways. 

The bill was put into consideration due to the undeniable fact that these first responders also suffer from trauma after responding to stressful situations. It is a recognition that while these workers were trained specifically to react in stressful circumstances, one cannot ignore the reality that they are still be affected by the situation.

Increase in Construction Fatalities and Workers’ Compensation In Colorado

There have also been talks of including cancer in the expansion for the firefighters due to the high health risk that their work supposedly entails. Several studies have tried to prove that firefighters have high risk of developing lung cancer due to their exposure to smoke and fumes.

While public employers understand the dangers that these first responders put themselves in whenever they go out, they are also concerned about the costs of expanding the compensation benefits. This would mean that they have to charge members higher than what they charge now in order to comply with said expansion.

Moreover, there is the question of how to determine whether diseases covered in the expansion are occupational diseases or contracted outside of work.

For instance, there has been a doubt as to including cancer in this expansion. Cancer is a disease which develops over time and usually takes time before symptoms can be seen or felt by the one afflicted. For this reason, it is hard to pinpoint whether the proximate cause for such sickness is the worker’s occupation.

While some studies say that firefighters have higher chances of developing cancer-related conditions, some studies have strongly disproved this fact. These conflicting studies result in major doubts to including cancer in the expansion.

Another issue is the inclusion of post traumatic disorder for first responders. There have been mixed reactions. Some say it would be absurd to afford these workers benefits for something that they were trained to handle.

The expansion of the workers compensation benefit for first responders is an ongoing process. If you need help from an experienced Colorado workers’ compensation attorney, please feel free to call us at (866) 356-9898 for your FREE CONSULTATION.


Exposure To Mold In The Workplace

Workers Compensation Blog

Many types of mold are hidden behind paint or walls. They can be inhaled even if they are covered. Mold is simply a member of the fungus family that grows spores. These spores can produce toxins that can cause health and breathing problems. Symptoms may not be clear and may not start immediately. Some symptoms will arise after prolonged exposure to the mold.

Some of the symptoms associated with mold exposure include:

• Difficulty breathing

• Allergy like symptoms

• Frequent headaches

• Flu-like symptoms that are not subsiding

• Lethargy or lack of energy

• Persistent cough


It is important to discuss possible mold exposure with your doctor. Testing can be done to rule out mold exposure or determine the type and severity of exposure you’ve experienced. Determining where the mold exposure took place is the next item on the list which will be followed by proper treatment.

The Centers for Disease Control (CDC) has an excellent website on mold in workplace buildings.  The recommend that you immediately report your concerns to your supervisor.  Our experience, representing workers with problems associated from mold, chemical and airborne contaminant exposure is to find other co-workers who are experiencing the same problems.  This will reduce the likliehood that the employer will deny the claim.

These kind of occupational disease claims can be difficult, expensive, and hard fought.  You need an experienced attorney to help you.  Click here or call us at (866) 356-9898 to contact us today to see how we can help you get your claim approved.

Highest Total of Monthly Laid Off Workers in 3 Years Recorded

Workers Compensation Blog

A total of 1,787 workers lost their jobs in the most recent mass layoff in Colorado last January. Eleven Colorado employers let go of at least 50 workers at a time yielding the highest monthly total of laid off workers in the state for the past three years. Following these layoffs are surging first time unemployment claims.

The mass layoff was one of the highest levels for Colorado in the past decade, but remains relatively- and fortunately- below the peaks of mass layoff in 2009 and 2010. Before this January, the highest number of workers let go in mass layoff was April in 2010, with 20 layoffs that resulted to 2,269 workers suddenly out of job.

The Colorado mass layoffs were among the 1,528 mass layoffs that took place nationwide during the first month of 2013. These mass layoffs involved 144,517 workers. The year before, there were more mass layoff actions at 1,705 but with lower number of workers involved at 141,703.

These mass layoffs have been affecting the employment in the entire state. Just last month, more than 200 temporary and permanent workers of California-based semiconductor company, Atmel Corp were laid off in Colorado Springs.

Naturally, unemployment claims increased dramatically this January as well. First time unemployment claims in Colorado surged by 221% following the mass layoff actions, based on data presented by the Colorado Division of Housing. A total of 1,787 unemployed workers sought unemployment benefits this January, way above the 556 first time unemployment claimants during the same month of last year.

State laws require claimants to have earned $2,500 during their base period; must be unemployed through no fault of their own- such as these layoffs of “reduction in hours or pay not related to performance”; and must be able, available and actively seeking work.

Previously, the monthly first-time unemployment claims in Colorado had been slowly but steadily decreasing since 2009.

Ryan McMaken, an economist with The Colorado Division of Housing, says that in general, the recent mass layoffs suggest that the employment situation continues to stabilize. And though the layoffs continue to lessen, the recent state employment data shows total employment is still below the 2008 employment peaks.

Experts say that these mass layoff does not automatically translate to higher unemployment- though the surge in first time unemployment claims is evident- assuming that new hiring is also ongoing. But for the state of Colorado, hiring remains vey moderate and would take long before these laid off workers get off unemployment benefits and start earning from working again.

Kaplan Morrell attorneys have handled thousands of workers compensation cases in Colorado. Contact Kaplan Morrell at 866 356 9898 today!

Workers Compensation Case Review

Workers Compensation Blog

Carrier is able to question generic referrals without incurring risk of penalties.

Colorado Workers Compensation Law prohibits employers, claimants, and insurers from dictating medical care.

Employers, insurers, claimants, or their representatives shall not dictate to any physician the type or duration of treatment or degree of physical impairment. Nothing in this subsection (3) shall be construed to abrogate any managed care or cost containment measures authorized in articles 40 to 47 of this title. CRS §8-43-503(3)

When Ms. Teagarden’s authorized treating physician, Dr. Pak, wrote a generic referral for her to treat with primary care physician for prescription refills, the carrier asked for clarification. The letter – addressed to “Whom it may Concern” – did not identify a specific doctor, did not state what body part was to be treated, explain the medical necessity of the treatment, and was written thirteen months since the last examination had occurred.

The insurance carrier filed an application for hearing on the issue of medical benefits, and also sent a letter asking Dr. Pak to clarify the letter. After a hearing on the medical benefits (which were awarded) Ms. Teagarden sought penalties for dictation of care.

The Administrative Law Judge (ALJ) denied the claim for penalties ruling that it had acted reasonably given the ambiguity over the identity, treatment, and body parts covered in the referral.

As always, how this or any other case we discuss in this blog would apply to your case depends on many more factors. We urge you to call us to see if you are entitled to workers’ compensation benefits. Workers Compensation is difficult, confusing, and very complex. Kaplan Morrell, a Denver workers compensation law firm,  has helped thousands of injured workers since 1997 get the benefits they deserve. Contact us here or call us at (866) 356-9898 for your FREE CONSULTATION.

Cite: Chun Cha Teagarden v. JC Penny, (WC No. 4-748-106, January 13, 2014)
Tags: Penalties, Dictation of Care, Authorization, Medical Benefits

Texting: New Causes of Work Injuries

Workers Compensation Blog

According to a survey conducted by AT&T, almost 98% of adults admitted that they text while they drive. The worse part is, they do it despite the fact that they know it’s wrong. Employees who get into accident because of negligence, particularly texting while behind the wheel, may not be eligible for workers compensation.

Figures: Accidents Caused by Texting while Driving

Based on statistics, more then 9 people are killed each day due to distracted drivers, and more than 1,060 of those injured in crashes are due to distracted driving. The use of cell phones while driving is considered one of the most common causes of road accidents, the act involving not only the movement of hands and eyes – but also the mind. To remedy the situation, the Governors Highway Safety Association said that DC and 39 states, including Colorado, had already banned all drivers from texting while they are on the wheels.

Using your mobile phone to text someone while you are in the driver’s seat can cause accidents. If you are a company driver whose work involves picking up employees to and from work, you may face charges in court for texting while driving.

Laws governing texting while driving may vary from state to state, but the punishment for such generally includes criminal charges, monetary fines, and prison time. Monetary fines can reach as high as $500. Criminal misdemeanor charges may result for violation of the laws. And if bodily injury or death resulted due to texting while maneuvering the steering wheel, the driver can be imprisoned. If you are a repeater, which means that you had been involved and had been caught violating the laws for the second time, the judge may choose a higher penalty or a longer sentence in jail.

Aside from legal consequences, drivers who text while driving may face other penalties for doing this, such as demerit points on their driving records, revocation or suspension of driving privileges, vehicle impoundment, or undergoing mandatory road safety classes. Driver employees should be aware that stricter regulations are imposed to commercial drivers and school bus drivers. For instance, truck and bus drivers who have violated the ban on texting while driving can be subject to fines as much as $2000 or more.

If you are facing criminal misdemeanor charges for texting while driving, you should contact a lawyer immediately, this being a serious offense. This is especially true if the violation caused great injury or death of the victim. You also need a lawyer if it is a repeat offense since punishments to second-timers are more severe than first-time offenders.

For businesses that rely on vehicles driven by employees, employers should be aware of the dangers associated with texting and repeatedly communicate this with their employees. Whether it involves talking on cell phones or reading and sending text messages while behind the wheel, the distracted driver is prone to serious accident. In fact, a lot of businesses have adhered to the call for responsible driving both by the government and non-government agencies and as such, they have developed strict driving policies as to the use of cell phones and other possible distractions while on the road.

Workers Compensation can be difficult, confusing, and very complex.  Kaplan Morrell has helped thousands of injured workers since 1997 get the benefits they deserve.   Contact us here or call us at (866) 356-9898 for your FREE CONSULTATION.

Workers Compensation Case Review: Factual Arguments Not Raised in Objection to Motion for Summary Judgment Cannot Be Raised on Appeal

Workers Compensation Blog

Claimant failed to respond to Respondents’ motion for summary judgement.  When it was granted she appealed, and alleged a number of factual allegations and documents.  The The Industrial Claims Appeals Panel (ICAO) did not consider them.


Parties are expected to submit their evidence before the ALJ. Frank v. Industrial Commission, 96 Colo. 364, 43 P.2d 158 (1935). The claimant here made no response to the respondents’ motion for summary judgment. The claimant’s petition to review contains allegations of factual disputes and various documents. The arguments and documents, however, were not presented to the Administrative Law Judge (ALJ) and we may not consider them now on appeal.


As always, how this or any other case we discuss in this blog would apply to your case depends on many more factors.  We urge you to call us to see if you are entitled to workers’ compensation benefits.  Workers Compensation is difficult, confusing, and very complex.  Kaplan Morrell has helped thousands of injured workers since 1997 get the benefits they deserve.   Contact us here or call us at (866) 356-9898 for your FREE CONSULTATION.


Cite:  Elizabeth Jones, WC No. 4-488-429 (January 29, 2014)