Older married women who hurt their backs are the class of workers whose injury claims are most likely to exceed adjusters' cost estimates, a new study finds.
The report from the Cambridge, Mass.-based Workers' Compensation Research Institute, based on data from 1996 through 2000, also found frequency of "adverse surprise" cases increasing in 12 states that were studied. Increases were largest in California and Texas, the WCRI said.
The report said that adverse surprise cases represent a significant share of medical costs in each state. It found that cases with significant or moderate surprises represent about 30 percent to 40 percent of medical costs in most states.
In California, however, surprise claims represented 57 percent of medical cost in the study period, compared with 15 percent in Indiana.
The researchers said they found that "adverse surprise cases are disproportionately back pain cases. Adverse surprises occur somewhat more frequently for women and are slightly more likely to involve older workers and those who are married," the report said.
In addition to California and Texas, states examined were Connecticut, Florida, Illinois, Indiana, Louisiana, Massachusetts, North Carolina, Pennsylvania, Tennessee and Wisconsin.
During the study period, the report found adverse surprise cases with more than seven days of lost time had gone up by 3.8 percent in California as compared with 0.4 percent for Wisconsin==the state with least increase.
In some of the states with larger increases, the findings "suggest that some of the adverse surprise cases in those states may be preventable==especially in California Florida, Louisiana, North Carolina and Texas.
WCRI said that the answer to increases likely would involve "some improvements in public policies and improvements in medical management," adding that "future studies should address this."
Legislative changes for workers' comp systems in California, Florida and Texas have occurred since the time period in the study.
Richard Victor, executive director of the WCRI, said the trend discovered in the study "may be driving reforms" and WCRI will be tracking the impact of the legislative changes.
California and Texas, he said, had made major changes in the way workers' comp system health care was delivered, noting that in Florida, "major changes had to do with reimbursement rates, which potentially affect access to care and adverse surprises."
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