Driven largely by skyrocketing medical costs and lack ofcontrols for utilization, workers' compensation insurance costshave risen 50 percent nationwide in the last three years, with thegreatest increases in California and Florida. The average medicalcost per claim has nearly doubled over the past decade, to $15,300and, in some states, the cost per claim has even quadrupled,according to the Insurance Information Institute.

In California, where workers' compensation premium rates are thehighest in the nation, the median number of medical visits perworkers' compensation claim is more than 70 percent greater thanother states. The higher utilization is due mainly to higher ratesof particular types of services, such as physical medicine andchiropractic care. Medical treatment frequently goes unchecked, andproviders lack incentives to curtail the number of visits.

Legislatures across the nation are passing or formulatingreforms of their states' workers' comp regulations. Too often,however, these reforms do not address the real issues. Mostreforms, even those that establish medical fee schedules that capsome reimbursements to providers and limit the number of visits tochiropractors and physical therapists, do not go far enough to fixthe system. The private sector also must offer strategies forsolving the crisis. Insurance companies and self-insured employersmust change the way that medical care is delivered and makehealth-care providers more accountable in order to lower costs andimprove the quality of care that workers receive.