Aching Back Is Top N.Y. Comp Claim Cause

A New York's workers' compensation system study has found employee back problems are the most frequent medical condition claimed by workers, and account for the largest share of the program's medical spending.

The "Flashreport" by the Cambridge, Mass.-based Workers' Compensation Research Institute was prepared in response to a request by the New York Insurance Department, which is drawing up injury treatment and disability guidelines in the wake of legislation reforming the state's comp law.

Non-specific low-back pain accounted for 13.9 percent of claims at an average cost of $1,864, while spinal disc conditions accounted for 4.5 percent of claims at an average per claim cost of $9,847.

The nonspecific low-back pain constituted nearly one-in-seven cases, WCRI said.

As part of various steps to implement the state's reform legislation, the department is preparing to write reports on medical treatment guidelines and disability rating guidelines, according to Hampton Finer, New York deputy superintendent for rates and reserves.

He said the department will write the treatment guidelines report first, noting that guidelines to approve specific types of care provided for an injury have resulted in a 44 percent savings for California's reformed comp system.

He said the department "didn't have a clear idea what kind of cost drivers" were involved in medical outlays, so it asked WCRI for the study "to get some sense of the top things we should focus on."

The reform process implementation has already seen the preparation of recommendations to streamline the adjudication of comp cases. Also in the pipeline is a report on the comp rating board and a data collection project, Mr. Finder noted.

Among the other findings in the WCRI report:

o Shoulder and arm conditions--both inflammatory conditions as well as sprains and strains--also accounted for a significant share of medical costs and cases. The inflammatory conditions were twice as costly as the sprains/strains--$5,451 versus $2,853.

o Knee derangements occurred in 2 percent of cases, but accounted for nearly 6 percent of medical costs--averaging more than $7,000 per case.

o Carpal tunnel conditions were diagnosed in about 2 percent of cases and represented about 3 percent of costs.