Many studies show that health care costs are concentrated among a small percentage of individuals with diverse needs. This new study defines high-cost claims as claims in the top 5 percent of medical payments at 36 months of injury and identifies key factors that likely contribute to a higher or lower probability of claims becoming high-cost claims. Among the key findings, it highlights the importance of monitoring claims that exhibit patterns of late occurring resource-intensive care to keep treatment on track as planned and prevent unnecessary delays in recovery.

The data for this study come from the WCRI Detailed Benchmark/Evaluation (DBE) database. The study analyzed more than 720,000 open and closed claims with more than seven days of lost time from 32 states. These claims had injuries from October 1, 2015, to March 31, 2019, with 36 months of experience observed from the date of injury up to March 31, 2022. The DBE database covers approximately 38–77 percent of all workers' compensation claims, varying by state, and the 32 states represent over 80 percent of the workers' compensation benefits in the United States during the study period.

Factors Associated with High-Cost Claims. Dongchun Wang, Kathryn L. Mueller, and Randall D. Lea. August 2024. WC-24-23.

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Copyright: WCRI