This 21st edition CompScope™ Benchmarks study for North Carolina continues to monitor the effects of major legislation passed in 2011, House Bill (HB) 709. One key provision of that legislation capped temporary total disability (TTD) benefits at 500 weeks (in most instances); previously, there was no duration limit on TTD benefits. This report includes claims occurring up to slightly more than eight years after the income benefit provisions of HB 709 became effective, so it provides a look at changes in patterns of some indemnity components that could be related to those provisions. New medical fee schedule rules became effective in 2015, with reimbursement based on a percentage of Medicare. Phased-in decreases in reimbursement for hospitals and ambulatory surgery centers (ASCs) went into effect beginning in April 2015, while changes in reimbursement for nonhospital (professional) services became effective in July 2015. The medical data we report reflect up to five years of experience following implementation of the new reimbursement rules. Taken together, the income benefit provisions in HB 709 and the hospital fee schedule reductions targeted the key cost drivers in North Carolina—slower return to work (hence longer duration of temporary disability), larger lump-sum settlements, and higher payments for hospital outpatient care as compared with the typical study state.

This study benchmarks the performance of state workers’ compensation systems in 18 states, focusing on income benefits, overall medical payments, costs, use of benefits, duration of temporary disability, litigiousness, benefit delivery expenses, timeliness of payment, and other metrics. It also examines how these system performance metrics have changed primarily from 2014 to 2019. We analyzed claims with experience through 2020 for injuries up to and including 2019. In some cases, we used a longer time frame to supply historical context for key metrics.

Note that the results we report include experience on claims through March 2020, at the very beginning of the coronavirus (COVID-19) pandemic. The study, therefore, provides a pre-COVID-19 baseline for evaluating the impact of the virus on workers’ compensation claims.

CompScope™ Benchmarks for North Carolina, 21st Edition. Carol A. Telles. April 2021. WC-21-12.

Copyright: WCRI