WCRI’s study looks at the factors behind high-cost compensation claims

High-cost workers’ compensation claims — or claims in the top 5 percent of medical payments within 36 months of an injury — accounted for 28 percent of all medical payments for injured workers between 2015 and 2019, according to a study released Thursday by Workers’ Compensation Research Institute.

“Our findings highlight the importance of monitoring critical care requests with late-arriving resources to keep treatment on the planned path 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 that the average medical payment for each high-cost claim was more than $100,000, more than seven times that for other claims that had more than seven days of lost time.

The study also showed that high-cost claims had longer periods of disability than non-high-cost claims and that the total costs of high-cost claims averaged more than $200,000 per claim.

The researchers said that the complexity of the injury is one of the most important factors related to a claim having higher costs, and that resource-intensive care is often associated with a higher likelihood of a claim becoming costly.

“Early identification of complex claims with comorbidities and degenerative conditions can also help better address worker needs, and a higher level of care coordination can help reduce the likelihood of a claim becoming a high-cost claim,” Mrs. Tanabe said.