A new study funded by the Center for Construction Research and Training (CPWR) confirmed a developing trend in workers' compensation: employees don't always use it when they can.

Instead, they regularly make claims under medical insurance plans for injuries or conditions developed as a result of work.

And while that shifts the costs away from one overburdened insurance system, it places those costs on another.

Workers' compensation systems are frequently the targets of reform intended to improve efficiency and care for workers. But the CPWR survey of almost 1,500 male floorlayers' health insurance claims revealed that the floorlayers were likely filing claims with union medical plans that would normally be considered work-related and eligible for workers’ compensation insurance coverage.

Fifty-one percent of the floorlayers filed claims and were diagnosed with a musculoskeletal disorder, compared to 39% of workers in other industries.

The data also indicated that young floorlayers, whose duties require them to work on their knees, file these claims at higher rates than other age groups.

The researchers identified many reasons for workers to prefer private health insurance over workers' compensation.

In some cases, filing a claim is the end of a floorlayer's career, because the only treatment for some knee conditions is a replacement.

While waiting for surgery, a worker who files the claim with private insurance has the option of continuing to work.

After a knee replacement procedure, the worker would not be able to kneel and employers often struggle to accommodate a worker with limited range of motion, says Dr. Ann Marie Dale, lead author of the study and assistant professor at Washington University St. Louis School of Medicine.

After a knee replacement surgery, a worker may receive partial pay but never again enjoy full knee function.

Rather than get the replacement, workers will sometimes manage knee problems with frequent medical care. and treatments that include regular draining of fluid, icing or medications. Treatments continue until the worker can afford to retire, says Dale.

Fiiling a workers' compensation claim puts future jobs at risk, the researchers suggest. Employers may during job interviews screen out job applicants who have previously filed workers' compensation claims, says Dr. Laura Welch, the medical director at the union-funded CPWR.

Difficulties of the Claim

Workers' compensation claims can also be more difficult to navigate than private insurance claims, and depending on the state and the type of private insurance, allow the injured worker a narrower choice of doctors.

“Employers encourage it [filling for medical rather than workers' compensation coverage] in a lot of ways,” says Welch. The incentives sometimes may include cash compensation to prevent a worker from filing a workers' compensation claim.

That's because workers compensation claims hinder a contractor's eligibility for jobs, says Dale.

This CPWR study findings support a similar study from 2009 that found a trend of union carpenters in Washington state filing work-related back injury claims with union-provided health insurance.

“There's no reason to think this is something unique about carpenters,” says Welch. In many trades, contractors have an incentive to minimize workers' compensation claims, and workers may see a private insurance claim as easier than a workers' compensation claim.

Questions of Ownership

The newest findings add urgency to the question of who exactly owns responsibility for a work-related injury.

Musculoskeletal disorders tend to develop over a long period of time. Among workers who change employers frequently, the most recent employer is not solely responsible for knee problems or carpal tunnel syndrome a decade or more in the making. The workers in the study used their union health fund to afford treatment. While unions might have an interest in making sure work-related musculoskeletal disorder claims are filed with workers' compensation, turning down a worker's claim runs counter to their interests, says Welch.

Dale adds that since those funds are usually funded with contributions by the employer, employers are still paying for that treatment.

Non-union workers may have even fewer options. 

To top it off, this report provides more evidence that workers' health issues start early in their careers. Once a disorder has begun to develop, solutions that benefit the worker and the employer are difficult to find.

“If we're going to start preventing these, we need to look at changing how the job is done,” says Welch.

Those changes might take just as long to make. Another report, published earlier this year in the American Journal of Industrial Medicine, found that workers' and employers' perceptions cause them to limit use of the ergonomic tools that might prevent musculoskeletal disorders or slow their development.

Respondents to that study, sadly, considered long-term work-related disorders an inevitable part of the job.