Life Cycle of a New York Workers’ Compensation Claim

By Carol A. Telles, William Monnin-Browder

January 16, 2025 Related Topics: Indemnity Benefits, Medical Costs, System Overview, Other

This study offers an in-depth look at workers' compensation claims in New York, focusing on the prevalence and costs of various claim types. The results provide a valuable overview of the types of claims that occur in the New York workers’ compensation system, the costs associated with them, and the timing of key payments, including lump-sum settlements. This information is useful for stakeholders to gain a more detailed perspective of the system and provides a helpful basis for evaluating future policy decisions.

The report analyzes workers’ compensation claims at a snapshot of time, claims from 2018 evaluated in 2023 (60 months after injury). It provides a thorough examination of overall claim costs, timing of key indemnity payments, and other essential system performance indicators. The data used to evaluate the frequency, costs, and timing of New York claims by claim type come from WCRI’s Detailed Benchmark/Evaluation (DBE) database. This information was collected from national and regional insurance providers and claims management organizations. The data underlying this report come from 15 companies representing a mix in terms of premium volume and claim share, as well as insured and self-insured employers.

Life Cycle of a New York Workers’ Compensation Claim. William Monnin-Browder and Carol A. Telles. January 2025. WC-25-01.

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Research Questions:

  •  What percentage of claims and associated costs pertain to each type of claim?
  •  For indemnity claims, when do key payments, such as the first indemnity or lump-sum payment, typically occur
  • What is the average total cost per claim, and how are costs distributed across categories (indemnity benefits, medical expenses, and benefit delivery costs)?
  • What percentage of claims remain open at the time of evaluation?

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