The Risk Matrix
Low Frequency, High Impact
Mega Loss Claims
Increased medical costs, longer life expectancies and improved post- trauma survival rates from unintentional injuries are three factors driving an increase in mega loss workers’ comp claims.
Research shows claims involving obesity were open 55 percent longer, and claims also including diabetes, hypertension and mental illness cost 341 percent more.
In 2017, three states approved bills to extend workers’ comp benefits to PTSD, requiring insurers to cover mental-health claims related to traumatic events.
High Frequency, High Impact
Slip and Fall
All falls account for roughly $70 billion in workers comp medical costs in the U.S. every year, according to the National Safety Council.
Temporary disability duration is 3x longer in claims involving long-term opioid prescriptions, according to a WCRI study.
Medical Cost Inflation
Medical costs account for 60 percent of workers’ comp claims. CDC data shows national spend on physicians and clinical services increased 400 percent from 1990 to 2015.
Low Frequency, Low Impact
Quality of Care
Claims that don’t apply evidence-based medicine are open 13.2 percent longer and cost 37.9 percent more in medical expenses than those adhering to ODG guidelines, as reported by the Journal of Occupational and Environmental Medicine.
Thirty states have legalized marijuana in some form, even though it remains a Schedule I drug under federal law. Workers’ comp payers have legal decisions to make before authorizing any request for medical marijuana.
High Frequency, Low Impact
Physical medicine accounted for as much as 30 percent of physician expenses in workers’ comp claims in 2017, according to the NCCI.
Workers’ comp fraud costs $7.2 billion annually and is the fastest growing segment of insurance fraud in the U.S. according to the National Insurance Crime Bureau.