Workers’ Compensation Medical Payments in Illinois Higher Compared with Other Study States

The average medical payment per claim with more than seven days of lost time in Illinois was more than 15 percent higher than the median of 18 states studied, according to a recent study by the Workers Compensation Research Institute (WCRI).

For 2017 claims (at 12 months), the average medical payment per workers’ compensation claim was 15 percent higher than typical. For 2015 claims (at 36 months), the average per claim was 30 percent higher.

The study, CompScope™ Medical Benchmarks for Illinois, 20th Edition, compared Illinois with workers’ compensation systems in 17 other states. For the study, WCRI analyzed workers’ compensation claims with experience through March 2018 for injuries up to and including 2017.

“Prices paid for professional services in 2018 were higher in Illinois than in most other study states,” said Ramona Tanabe, executive vice president and counsel of WCRI. “This was due to relatively high fee schedule rates, which ranged from about 45 to 513 percent above Medicare rates in Illinois in 2019. But fee schedule rates for evaluation and management services – office visits – were slightly above Medicare rates.”

The following are among the study’s other findings:

  • Illinois had among the highest utilization of medical services of the study states at all claim maturities, largely driven by physical medicine.
  • Between 2012 and 2017 (claims at 12 months), Illinois medical payments per claim with more than seven days of lost time increased an average of 1.9 percent per year. The small growth in prices (1.2 percent per year) was consistent with the design of the Illinois medical fee schedule to update changes using the Consumer Price Index for All Urban Consumers.
  • In 2018, the average price paid for evaluation and management services was 15 percent lower in Illinois than in the median of 36 study states.

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