High workers compensation claims costs – or claims in the top 5% of medical payments within 36 months of injury – represented 28% of total injured employee medical payments between 2015 and 2019, according to a study released Thursday by the Workers Compensation Research Institute.
“Our findings highlight the importance of monitoring claims with late occurring resource-intensive care to keep treatment on track as planned and prevent unnecessary delays in recovery,” WCRI President and CEO Ramona Tanabe said in a statement.
Researchers analyzed more than 720,000 open and closed claims with more than seven days of lost time from 32 states.
The study found the average medical payment per high-cost claim was more than $100,000, more than seven times as high as that for other claims that had more than seven days of lost time.
The study further showed that high-cost claims had longer periods of disability than non-high-cost claims, and that total costs of high-cost claims averaged more than $200,000 per claim.
Researchers said injury complexity is one of the most significant factors connected to a claim having higher costs, and that resource-intensive care is often associated with a greater likelihood that a claim will become high-cost.
“Early identification of complex claims with comorbidities and degenerative conditions can also help better address workers’ needs, and a higher level of care coordination likely helps to reduce the probability of a claim becoming a high-cost claim,” Ms. Tanabe said.