Regulatory Tag: Claim Costs

A new study from the Workers Compensation Research Institute found that injured workers treated in medical provider networks have lower medical and total claim costs, faster access to care, and improved disability outcomes.

While opioid utilization has decreased, overall spend on pain management has increased, in part due to the use of high-cost topical medications.

Both claims reach costs of $1 million or more, but at different points in time after injury.

Claims exceeding $1 million in costs saw a projected home health share of medical costs reach 20.1%.

Average medical equipment costs increased 87% from 2012-2024, with medical equipment representing 8.3% of total workers’ comp medical spend.

Using data representing 60% of workers’ comp benefits nationwide, these reports examine trends in payments, prices, and utilization.

The webinar covered topics ranging from claims costs to drug payments, heat-related injuries, and more.

Only 42.8% of injured workers on FRPs had a chronic pain diagnosis, even though clinical guidelines recommend FRPs only for these cases.

Reviewing 194,000 claims, the report found that claims with degenerative comorbid conditions are 58% more likely to become a high-cost claim.

While overall medical inflation remains low, certain tariffs are still pending, which could impact long-term costs.

Medical costs went up 8% in 2024, driven by increased utilization, fee schedule inflation, and growth in medical-legal services.

Initial treatment from nurse practitioners saw a 2.3% shorter time from injury to the first non-emergency service.

The report covers trends from 2003 to 2023, looking at claim frequency and costs, vocational rehab, dispute resolutions, and more.

An 8.7% increase will take effect on September 1, 2025, slightly below the WCIRB’s suggested 11.2% increase.

The meeting covered 2024 healthcare costs and utilization, along with incoming regulatory changes.