The WCRI said the study analyzed more than 720,000 open and closed claims. (Credit: danielfela/Shutterstock.com)
Nearly a third of all medical payments within three years of an injury exceed $100,000 on average, according to the latest study by the Workers' Compensation Research Institute (WCRI).
The data showed high-cost claims make up 28% of total medical payments for employees with more than seven days of lost time.
The WCRI said injury complexity like fractures between the ankle, hip and pelvis make claims eight to nine times more likely to be high-cost.
Meanwhile, late resource-intensive care, or medical claims exceeding $10,000 every month for over a year, and individual characteristics like age and financial positioning are also contributing factors associated to high-cost claims.
"Our findings highlight the importance of monitoring claims with late occurring resource-intensive care to keep treatment on track as planned and prevent unnecessary delays in recovery," WCRI President and CEO Ramona Tanabe said. "Early identification of complex claims with comorbidities and degenerative conditions can also help better address workers' needs; and a higher level of care coordination likely helps to reduce the probability of a claim becoming a high-cost claim."
High-cost claims averaged $103,368 in medical payments the first 36 months of treatment, $71,990 in indemnity payments, and $200,603 in total costs, which included medical payments, indemnity benefits and benefit delivery expenses, the data showed.
The WCRI study included claims with more than seven days of lost time from injures occurring between Oct. 1, 2015 and March 31, 2019, with medical treatment benefit payments evaluated at 36 months from the injury through March 31, 2022, the data showed.
The WCRI study analyzed more than 720,000 open and closed claims.
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