Excellent research on high-cost work comp claims by NCCI’s Brett Foster and Yuchen Su indicates that we need to take a step back and revisit how we characterize, think about and manage catastrophic claims.

Joe Paduda

Su and Foster categorized claims into fast-emerging (incurred losses of $1 million in the first 24 months) and slow-emerging (post-24 months). 

First, top takeaways.

• Causation: Fast claims are often caused by motor vehicle accidents and falls from elevation. Slow claims are often linked to strains and lifting injuries.
• Shrinkage: As a percentage of all claims, cat claims are dropping. The only category that increased was >$1 million fast-emerging claims; the share of fast and slow >$500k and >$1,000k slow-emerging claims decreased.

The number of really expensive claims — as in, $2 million — has been pretty much level for two decades.

A couple of details

NCCI opines that the concomitant drop in fast-emerging claims and the increase in slow-emerging claims may be due in part to better/earlier identification of potentially high-cost claims — those that would have been identified fewer than two years after inception in the old days are now ID'd early on.

NCCI also thinks the change in opioid utilization may be a factor driving down costs for the slow-emerging claims. I sent a follow-up query to NCCI and will report back.

What does this mean for you?

Good work by lots of people produces good results for injured workers, employers and taxpayers.

Joseph Paduda is the principal of Health Strategy Associates, a consulting firm focused on improving medical management programs in workers’ compensation. This column is republished with his permission from his Managed Care Matters blog.