Medical Services and How They Contribute to the Cost of WC Claims

Medical Services and How They Contribute to the Cost of WC Claims

Not all workers compensation claims are equal when it comes to medical treatment. You don’t usually see the same doctor for a broken toe as you would for a head trauma. In fact, the more serious the injury, the more likely you are to receive a complicated mix of healthcare services, organized into “service groups” (think: inpatient hospital, anesthesia, physical therapy, prescription drugs).

Trying to understand and predict medical cost trends is tricky across service groups because they are all influenced by different factors. And the mix of medical services tends to vary by claim size and claim length, not to mention where services come into play in the life span of a claim. For example, emergency room services will typically be used before physical therapy.

To help make sense of this challenging mix, NCCI has updated its research on “Medical Services by Claim Size” last published in 2011. Among the findings you will see:

  • For smaller claims, below $500K, outpatient hospital (ambulatory) services make up the biggest portion of costs
  • Larger claims are more influenced by inpatient hospital charges, and costs for home healthcare spike for claims exceeding $1M
  • The bigger the claim, the longer the treatment period and thus, the longer the payout period
  • Prescription drug payouts linger the longest, regardless of claim size

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