Since workers’ comp rules and regulations vary widely across states, it only makes sense that workers’ comp fee schedules vary widely as well; you can find some more information about them on the U.S. Department of Labor’s website here and states have their own materials published online that you can find. Many states have fee schedules that reimburse providers at a set maximum limit. The Workers’ Compensation Research Institute (WCRI) set out to answer the question of whether states with higher fee schedules also had a higher number of workers’ compensation cases- maybe as a result of the higher reimbursements that doctors would see if their case was considered a workers’ comp cost rather than something like a Medicare or other group health injury.

The researchers established that a large number of states set their fee schedules up to around 15 percent higher than the state’s Medicare reimbursement rate, and most all of the states had a higher rate for workers’ comp than they did Medicare. Some states set theirs at more than double the state Medicare rate, and others who had the highest fee schedule set theirs at about three times the rate of Florida, a state with the lowest fee schedule. States who do not have fee schedules for workers’ comp saw higher prices overall for workers’ comp claims which may be part of the reason many states are encouraged to set workers’ compensation fee schedules in the first place. A previous study from WCRI suggested that states without fee schedules have higher costs for outpatient treatments as well.

It is often up to the treating physician to decide whether a treatment is work-related or not, especially in injuries that are not obvious, like a soft-tissue injury or a cumulative trauma injury. This kind of case-shifting to workers’ comp is more prevalent in “blurred lines” kinds of cases than in a cut and dry case like a broken arm or a cut, particularly in states with higher fee schedules. They estimate that in situations where a patient was receiving physician services at an office visit, in a state with a fee schedule that reimbursed them 20 percent more than the average rate, physicians were likely to label up to 6 percent of these soft-tissue injuries as work-related. They did not find similar evidence of this percentage of case-shifting for cases where the cause of injury was more obvious.

This is no small percentage. Researchers pointed out an example for the state of Pennsylvania. If 1 percent of cases in that state that should have been labeled and paid for by group health were paid for by workers’ compensation, it would amount to an increase in comp costs of $35,000,000. In states with a higher fee schedule the costs could climb even more.