The National Council on Compensation Insurance (NCCI) recently released a comprehensive study examining "mega claims" in workers' compensation insurance. These are claims with reported losses exceeding $2 million, representing a small fraction of total claims but a significant portion of total loss dollars. The study covers accident years 2001-2021, providing valuable insights into trends and patterns within this high-cost category.
Showing posts with label Injury. Show all posts
Showing posts with label Injury. Show all posts
Thursday, December 12, 2024
Thursday, December 12, 2013
Wah, Wah, Wah
At least that's the message that I got out of the latest study from researchers at National Institute for Occupational Safety and Health in their study just published by the Journal of Occupational and Environmental Medicine. According to them, accepted workers' compensation claims that do not result in medical payments could be costing group health insurers at least $212 million a year because folks who don't get their treatment through work comp for their work injuries or illnesses do so through their group health provider. Claims that do not result in medical payments through work comp are referred to as "zero-cost claims" in the study. The researchers' analysis of more than 12,000 claims from 2002 through 2005 revealed that 15.9% of the claims were zero-cost claims. Claimants with zero-cost claims were more likely to use group health insurance services and incur more group health costs. "In the three months before an occupational injury, 53.9% of workers with positive-cost workers' compensation medical claims and 61.6% of workers with zero-cost workers' compensation medical claims used the outpatient group health insurance at least once," the study says. "Within three months after an occupational injury, group health insurance utilization for outpatient services increased to 61.2% and 74.1% for workers with positive- and zero-cost workers' compensation medical claims, respectively." In addition, one of the study's most significant findings... |
Wednesday, December 11, 2013
More Cost Shifting
A recent study reports that zero-cost workers' compensation claims merely creates cost shifting to other programs.
Objective: Previous research suggests that non–workers' compensation (WC) insurance systems, such as group health insurance (GHI), Medicare, or Medicaid, at least partially cover work-related injury and illness costs. This study further examined GHI utilization and costs.
Methods: Using two-part model, we compared those outcomes immediately after injuries for which accepted WC medical claims made zero or positive medical payments.
Results: Controlling for pre-injury GHI utilization and costs and other covariates, our results indicated that post-injury GHI utilization and costs increased regardless of whether a WC medical claim was zero or positive. The increases were highest for zero-cost WC medical claims.
Conclusion: Our national estimates showed that zero-cost WC medical claims alone could cost the GHI $212 million per year.
How ALEC Serves As A 'Dating Service' For Politicians And Corporations
| ALEC has endorsed workers' compensation as program to shield corporate liability. " NOW THEREFORE BE IT RESOLVED, that the State of (insert state) specifically reaffirms the principle of workers’ compensation as the exclusive remedy and rejects the rationale for tort liability based on legal theories such as dual capacity/dual persona, intentional injury without proof that the employer acted with deliberate intention to cause the injury, or third party action against employers for work-related injuries." Today's post is shared from NPR.org . A batch of internal documents recently leaked to The Guardian has revealed new insights into the goals and finances of the secretive group called ALEC. The American Legislative Exchange Council is a group that brings together state legislators and representatives of corporations. Together, they develop model bills that lawmakers introduce and try to pass in their state legislatures. Through these model bills, ALEC has worked to privatize public education, cut taxes, reduce public employee compensation, oppose Obamacare and resist state regulations to reduce global warming gas emissions. "ALEC is like an incubator of predominantly conservative legislation," Guardian correspondent Ed Pilkington tells Fresh Air's Terry Gross. "The vast majority of the model bills are conservative in their... |
Sunday, November 17, 2013
Latest firefighter injury report shows that nearly 70,000 injuries occurred in the line of duty in 2012
 NFPA released the latest edition of its U.S. Firefighter Injury Report, highlighting data on injuries sustained by firefighters on duty that was collected from fire departments responding to the 2012 National Fire Experience Survey. Firefighter injuries have declined over the past three decades, hovering around roughly 100,000 from the early 1980’s through early 1990’s. In 2012, 69,400 firefighter injuries occurred in the line of duty.
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Thursday, February 21, 2013
Out-of-State Work-Related Injuries: What You Need to Know
Today's post comes from guest author Brian M. Wright from Causey Law Firm of the State of Washington
In all of the above scenarios, you may have the ability to file your claim in multiple states. Generally, you will have the option of filing in:
1) the state in which you were injured;
2) the state in which you primarily worked; and
3) the state in which you entered into your employment contract.
If you are injured outside Washington, or whatever state in which you normally work, it is important to evaluate your options and file wherever you might have a legitimate claim. It is possible that you have remedies available to you in more than one state.
Wednesday, November 17, 2010
Congresswoman Woolsey Calls For A GAO Study of Workers Compensation-Cites Insurance Company Cost Shifting
Below are the prepared remarks of U.S. Rep. Lynn Woolsey (D-CA), chairwoman of the Workforce Protections Subcommittee, for a subcommittee hearing on “Developments in State Workers’ Compensation Systems” 11.17.2010
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Thank you all for attending this hearing on “Developments in State Workers’ Compensation Systems.” Here in Congress, we don’t examine these state compensation programs very often because they are generally under the purview of state legislatures.
Thank you all for attending this hearing on “Developments in State Workers’ Compensation Systems.” Here in Congress, we don’t examine these state compensation programs very often because they are generally under the purview of state legislatures.
However, there have been some disturbing national trends that may compel a comprehensive reexamination of these state programs and their impact on injured workers.
As most of you are aware, workers’ compensation statutes were passed beginning in the early 20th century to establish a no fault system for providing efficient redress for injured workers.
Workers’ compensation was called the ‘grand bargain.’
Workers waived their rights to bring individual suits against their employers and in return receive compensation for work-related injuries regardless of fault.
Every state and the District of Columbia have workers’ compensation programs in place.
Most employers purchase private workers compensation policies, but others self-insure or purchase insurance from a state managed compensation fund.
Beginning in the 1990s, changes in state workers’ compensation laws--brought about by the lobbying efforts of employers and insurance companies---have resulted in stricter eligibility requirements and the reduction in both the amount and duration of benefits—particularly for those workers with permanent partial disabilities.
Unfortunately this ‘grand bargain’ of the 20th century is not so ‘grand’ any more, especially for injured workers.
In addition, there are two other recent developments that merit our attention
The first has to do with the American Medical Association’s (AMA) Guides to Permanent
Impairment.
And the second concerns a cost-shifting trend away from state workers compensation programs, where the employer is responsible for an employee’s injury, to the federal government’s medical and disability programs.
The AMA Guides have been in effect since 1971 and are now in widespread use.
Some states even require workers’ compensation programs to use the latest edition of the Guides.
These Guides were originally designed to be used by physicians in making a scientific assessment of a worker’s level of impairment---or loss of function---due to a work-related injury.
The determination of whether a worker is permanently disabled and entitled to workers compensation is based upon his or her impairment rating, which is then applied to the specific case of a given worker.
For example, a worker who loses a hand may not suffer permanent disability if he or she is a teacher, but that same worker would be permanently disabled if he or she works in construction.
In 2007, the AMA published the 6th edition of the Guides, and witnesses today will describe how this new edition has dramatically reduced impairment ratings for many types of conditions, without apparent medical evidence, and transparency.
The 6th edition has become so controversial that many states, including Iowa, Kentucky and Vermont have decided not to adopt them.
It also appears that the 6th edition was developed in near secrecy, without the transparency and consensus which should necessarily accompany the development of standards that will have widespread use by state governments.
In addition, it appears that the physicians who developed this latest edition may have ties to insurance companies, and are making a profit training doctors on the use of the 6th edition, which is complicated and very difficult to apply.
The National Technology Transfer Advancement Act of 1996 sets forth minimum criteria for the development of voluntary consensus standards: openness; balance of interests; due process protections; and consensus.
The process used for developing the 6th edition appears to significantly deviate from these standards and is a focus of testimony before us today.
Workers who are wholly dependent on this ‘grand bargain’ when they are injured on the job, are the ones paying the price.
The subcommittee invited the AMA to testify today, but unfortunately, it declined.
Another troubling policy issue is that as eligibility for workers’ compensation benefits have become more restrictive, there has been a cost shift to Medicare and Social Security Disability (SSDI), placing an additional burden on the taxpayer.
In addition, costs are being shifted to private health insurance that should be borne by workers’ compensation policies and employers.
This is particularly worrisome, especially during a time of record deficits.
Chairman Miller and I believe that this cost-shifting trend warrants further study.
Therefore, we will be asking the Government Accountability Office (GAO) to do a study and issue recommendations.
The testimony today will illuminate these problems facing injured workers and taxpayers, and I look forward to hearing from our witnesses.
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