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.

Marijuana Use Can Impact Your Workers’ Compensation Benefits

Marijuana Use Can Impact Your Workers’ Compensation Benefits

Denver Workers Compensation

When it comes to marijuana use on-the-job, the best advice is “don’t do it!” Contrary to what you may believe, whether for medical or recreational uses, your right to toke is not protected by law in the work environment. Colorado has legalized both the medical and recreational consumption of marijuana, but our state laws still butt up against federal laws. And this makes for lots of confusion across the board.

Employers on Marijuana Use

Legal marijuana, whether for medical reasons or recreational use, is no mandate for use at work. Employers are well within their legal rights to prohibit consumption at work and to require drug testing to weed out users from their workforce.

Federal law prohibits the possession and consumption of marijuana for any reason. This supports the rights of employers in banning marijuana consumption in their employees. Now that the new Trump administration is in place, federal versus state law on marijuana may become even murkier. Currently, there is no clear-cut answer on whether the federal government will be cracking down on states that allow legal marijuana use.

Statewide Marijuana Use Laws

As of the November 2016 election, more than half of all the states in the union, plus D.C., now have medical and/or recreational marijuana use legislation on their books.

1. California passed legal recreational marijuana use last November.
2. Massachusetts joined the ranks of recreational marijuana use states this past election.
3. Maine will soon be allowing limited recreational marijuana use and on-site consumption in social clubs.
4. Though late to the party, Nevada is now a legal recreational marijuana state.
5. Washington, D.C. voted for nonmedical marijuana use in 2014.
6. Oregon came aboard on recreational use of marijuana in the summer of 2015.
7. Alaska passed recreational marijuana law in 2015.
8. Colorado passed legislation to allow recreational marijuana use in 2012. Recent ballot initiatives support public consumption programs in Denver.
9. Washington joined Colorado in groundbreaking recreational marijuana use in 2012.
10. Florida, Arkansas, North Dakota, Montana, Arizona, New Mexico, Minnesota, Michigan, Illinois, Louisiana, Ohio, Pennsylvania, New York, Vermont, New Hampshire, Connecticut, Rhode Island, New Jersey, Maryland, Delaware have all legalized medical marijuana.

Bottom Line: Colorado Statute on Marijuana and Workers’ Compensation

Regardless of what the future holds for legal marijuana consumption, for now, Colorado Statute, Article 42 of Title 8 limits your financial benefits under the workers’ compensation system if you test positive for a controlled substance. You can lose 50 percent of your income replacement benefits if marijuana use is detected. While you will still receive full medical treatment benefits, your finances will likely suffer greatly from this impact.

Note that the issue with federal vs. state laws on marijuana impact this area of the law as well. §8-42-112.5. C.R.S. excludes medically prescribed drugs from the identified controlled substances, but that’s the problem. Doctors in Colorado cannot prescribe marijuana. They can only advise their patients on its use.

If you have questions about marijuana and the workplace and workers’ compensation benefits, ask a lawyer. Your pot-smoking buddy probably has a lot of opinions and knows quite a bit about the legalities of smoking weed in Colorado. But workers’ compensation is a complicated system wherein state and federal laws often overlap. A Colorado workers’ compensation lawyer is your best source of information on this thorny subject. We’re always here to answer your questions- don’t wait- get a free consultation on your workers’ compensation case now.