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Medicare Set Asides Cause Claim Counts To Spiral?


Medicare Set Aside Claim Counts

I was reading a few articles this week on the rise of Workers Comp claim counts. I was astonished at the number of open Workers Compensation claims. Are some TPAs, employers, and insurance carriers deciding to leave their claims open for a longer time, if not indefinitely?

Vector Graphic Of Medicare Set Aside Claim Counts Insurance Icons

I thought I would research the numbers further, using public information rating agency data. A report by NCCI dated 02/12/11 reported that the TTD period is presently lengthening between 2006 and 2009 due to a 12.3% increase during that period. This could have counted for the increase in the number of open claims overall. However, TTD is not necessarily adding to the claim counts. TTD, by definition, is a temporary benefit figure.

NCCI has also said that the average cost for the medical benefits on lost time claims had increased from $23,000 to $28,000 in the aforementioned period. This is an overall increase of 21.7% for all four years combined.

The number of Workers Comp claims likely increased by 3% nationwide in 2010, but the number of claims decreased over 2006 – 2009 by 16.2%. In a nutshell, claims decreased by 16.2% cumulatively however the medical benefits per claim increased by 21.7% over the same period. Those are very eye-opening numbers.

Does this mean MSAs are changing the Workers Comp landscape? I will cover that next time.

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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