Workplace injuries and case-shifting

When South Carolina workers sustain injuries while engaged in the course and scope of their employment, many of them are eligible to receive compensation through their employers’ workers compensation insurance carriers. Some injuries are straightforward and easily traceable to a work accident, such as a fracture or puncture wound. Others, however, may be more difficult to pinpoint.

When a worker suffers an injury, such as a soft-tissue injury, the examining doctor will determine whether or not it is job-related. This information is then used to decide whether or not the person is eligible for workers’ compensation benefits for treatment and other associated costs.

An article appearing in Business Insurance states that some doctors tend to attribute soft-tissue injuries to the person’s job even when they may have resulted from a different activity. The industry calls this practice case-shifting, and observers believe that doctors do so to get the higher medical care rates they can receive from workers’ compensation insurance rather than from the employee’s normal health insurance.

This claim by the workers’ compensation insurance industry demonstrates the type of argument employers and their carriers may make when disputing a worker’s claim for benefits. With workers’ compensation, insurance companies pay for the entire cost of care as opposed to the employee having to make co-pays and deductible payments. Workers’ compensation benefits may also pay monthly amounts for disability payments to injured workers if they are left disabled from their workplace injuries. Because companies and insurance carriers like to keep their costs low, they may try to claim that the injury did not result from the person’s job but instead happened because of a different cause. Workers who have been injured may need to get help from an attorney if this happens.