Today’s Workers’ Comp market is generally favorable, but several emerging medical and demographic challenges have the potential to upset the current balance. By better understanding the possible impact of these new variables on the market, buyers and brokers will be able to continue to protect employees—and their bottom lines.
MEDICAL CHALLENGES
1. The Affordable Care Act may well increase Workers’ Comp costs by increasing demand for medical services from a fixed number of providers. If more Americans can buy medical services, the cost of those services will rise. Beyond higher prices, greater demand will also lead to longer treatment and recovery times as claimants wait to get appointments, potentially impacting indemnity costs.
2. The growing use of—and cost for—physical therapy causes challenges. Fee schedules for physical therapy have increased over the past two years in nine states that have the greatest use of PT in Workers’ Comp claims. California increased its fee schedule for all physical therapy billing codes by 5% to 6% in March, while New Jersey upped its schedule by 3.6% last fall. Managing the utilization and cost of physical therapy is becoming a key issue, so much so that clients, prospects and brokers are asking TPAs more questions about their strategies in this area.
3. The variability of WC costs and treatments among states threatens the  market. There is no reason why the cost for treating the same type of work-related injury should differ significantly from state to state—but it does. The median medical benefit per Workers’ Comp claim by state is $26,124, according to NCCI data. California and Delaware have medical benefits per claim over 50% greater than the median, while Massachusetts and Rhode Island are well below half the median.
There is good news, however. Medical treatment guidelines and drug formularies continue to be developed in states across the country. As experts with a shared interest in cost-effectively delivering quality medical outcomes for injured workers, all of us must understand this issue, and translate that understanding into action by becoming involved in efforts to improve workers’ compensation systems and develop treatment guidelines and formularies.
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enhance the agency’s ability to target our resources to save lives and prevent further injury and illness. This new data will enable the agency to identify the workplaces where workers are at the greatest risk and target our compliance assistance and enforcement resources accordingly.”