Study: Indiana Workers’ Comp Average Medical Claims Higher than Most States

A recently published study from the Workers Compensation Research Institute found that the average medical payment for Indiana workers’ compensation claims with more than seven days of lost time was higher than the typical state.

The study, CompScope™ Medical Benchmarks for Indiana, 22nd Edition, compared Indiana’s workers’ compensation system with systems in 17 other states. The WCRI analyzed workers’ compensation claims with experience through 2020 for injuries up to and including 2019.

The average medical payment per claim with 12 months of experience was $20,564, 45% higher than the median state.

The study cited the above-typical prices for professional nonhospital services as the main reason for the disparity in medical payments per claim.

“Facilities, particularly ambulatory surgery centers, or ASCs, contributed to the higher-than-typical payments in Indiana,” said Ramona Tanabe, executive vice president and counsel of WCRI. “The average ASC facility payment per claim was among the highest of the 18 states, and the percentage of claims with facility payments was higher than typical for both ASCs and hospital outpatient departments.”

Other key findings from the study include:

  • Hospital payments per claim, both overall and for inpatient and outpatient services, were fairly typical. Hospital payments per claim were among the highest of the states studied prior to the implementation of a hospital fee schedule in 2014.
  • Prescription drug payments per claim were lower than the typical state studied, a result of lower payments per prescription.
  • Between 2014 and 2019, the average payment per prescription in Indiana decreased 1 percent per year, the number of prescriptions per claim decreased 5 percent per year, and the proportion of claims with prescriptions decreased. The magnitudes of those changes were similar to other states studied.

WCRI is a Cambridge, Massachusetts based independent, not-for-profit research organization.

This article was first published in Insurance Journal.

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