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NCCI – Massive New Study On Long Term Claims


Massive New Study On Long Term Claims

NCCI has recently published what I would refer to as a very hybrid study of the long term medical costs on Workers Comp claims.  Claims data is usually examined by NCCI, the WCIRB (CA Rating Bureau), and other rating bureaus with a corresponding time frame of just a few years.

Picture Of Man Long Term Study On Computer

The 35 jurisdictions for which NCCI provides ratemaking services are AK, AL, AR, AZ, CO, CT, DC, FL, GA, HI, IA, ID, IL, KS, KY, LA, MD, ME, MO, MS, MT, NE, NH, NM, NV, OK, OR, RI, SC, SD, TN, UT, VA, VT, and WV. The seven independent bureau states for which NCCI collects the Medical Data Call are IN, MA, MN, NC, NJ, NY, and WI.

The data time frame actually covered claims from the 1980’s and forward.  The amount of data had to have been huge. One of the main quotes from the study, “It is likely that more than 10% of the cost of medical benefits for the workplace injuries that occur this year will be for services provided more than two decades into the future. That percentage has been growing and might continue to grow. ” 

Picture of doctor holding piggy bank with stethoscope long term claim concept

At first glance, that may seem to be an astounding figure until the complete Workers Comp landscape is examined including the very settlement- detrimental Medicare Set Asides.  The settlement timeframes have been altered as paying upfront very heavily for medical services that may never be incurred has caused many carriers to not push for settling the clams on a full closure basis.

In other words, why pay upfront for an expense that may never occur?  This paradigm shift was initiated by the CMS (Center for Medicaid/Medicare Services)  having to approve many of the Workers Comp settlements.  Many claim staffs had to shift their way of thinking on closing out large Workers Comp files.

One could have seen the growth of the long term medical files as claim adjusters started recommending leaving the medical portion of a file open forever for palliative care.

Two of the larger cost drivers for long term files were prescriptions and home health care services.  Prescriptions were even seen as possibly in the future becoming 50% of the long term medical costs of older files.

One assumption negated by NCCI was that older workers were the ones that would be responsible for a large majority of the costs.  This was proven as a fallacy as injured employees less than 60 years of age accounted for a very small portion of long term medical treatment costs.

The finding is in line with a study published last year by NCCI that proved older worker accident rates are much lower than younger workers.

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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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