BACKGROUND: Workers' Compensation differs from standard insurance, and it is unclear how or if Workers' Compensation insurance influences the diagnosis and treatment of hand and wrist disorders. The aim of this study was to compare the diagnosis and course of treatment of hand disorders between patients with Workers' Compensation insurance and patients with standard insurance. METHODS: The complete medical records of patients who visited an academic orthopaedic hand clinic between January 2005 and January 2007 were reviewed, and information on patient history, utilization of diagnostic tests, diagnosis, surgery, and wait- time to surgery was collected. Patients with Workers' Compensation insurance and those with other, third-party coverage were analyzed and compared. Patients without insurance were excluded from this study. RESULTS: 1413 patients (representing 2121 diagnoses) were included in the study. One hundred and sixteen patients (8%) had Workers' Compensation insurance and 1297 patients (92%) had standard insurance. Patients with Workers' Compensation insurance were younger than patients with standard insurance (mean age, forty-three years compared with fifty years, respectively; p textless 0.05) and were also more likely to be male (50% compared with 40%, respectively; p = 0.04). Generally, Workers' Compensation patients more often had neurological conditions (p textless 0.01), but there was no significant difference in the most common diagnoses between the two groups. Patients with Workers' Compensation underwent surgery slightly more often than did patients with standard insurance (44% compared with 35%, respectively; p = 0.07) and had a higher average number of visits before undergoing surgery (2.3 visits compared with 1.2 visits, respectively; p textless 0.05). Twenty-three (45%) of the fifty-one patients with Workers' Compensation insurance who received a diagnosis indicating the need for surgery underwent surgery after the first visit, compared with 316 (69%) of 458 patients with standard insurance (p textless 0.05). Patients with Workers' Compensation insurance were more likely than patients with standard insurance to undergo electrodiagnostic testing (26% compared with 15%, respectively; p textless 0.01) or magnetic resonance imaging (16% compared with 9%, respectively; p = 0.02). CONCLUSIONS: Compared with patients receiving standard insurance, patients receiving Workers' Compensation insurance have a greater number of clinic visits before undergoing surgery and receive more diagnostic testing. More research is needed to explore these differences and their potential clinical and economic consequences.