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Workers Compensation Medical Treatment Lag Time – WCRI


WCRI – Time From  First Injury To Workers Compensation Medical Treatment – Comparison Across 18 States

Most Workers Compensation medical treatment foretells how a claim will progress over its lifetime.  One of My Six Keys To Saving  on Workers Comp claims involves having a preset medical network in place.

The other likely involved key concerns the timely filing of the medical report.

picture of injured workers compensation medical treatment by Red Cross
Wikimedia License

These two keys can easily escalate a claim to over 800% more than if the first report filing time – called employer reporting lag time– tallies in with a high number along with the medical treatment not being provided to the injured employee ASAP.     The 800% figure came from my research into claims on two different public entity sets of files that involved over 10,000 claims.

The study can be purchased here for $5, yes just $5 for a great study.

WCRI (Workers Compensation Research Institute) attempted to answer three different questions.  I was hoping the answers to these three questions would agree with my old research.

Those three questions were:

  • How much variation was there across states in the time from injury to first treatment for physical medicine and “specialty” services (such as surgery, major radiology, and pain management injections) across injury types?
  • Were there consistent patterns in time to first medical treatment; that is, did some states show shorter or longer time to treatment across injuries and services?
  • How much variation was there across states in the time from injury to first treatment for “entry” services, such as emergency, office visits, and minor radiology?

The study’s data sets were:

The study examines claims with more than seven days of lost time for injuries occurring from October 1, 2014, through September 30, 2015, evaluated as of March 31, 2016.   This would, in a way, eliminate medical only claims from the data set.

The 18 states in the study are Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Texas, Virginia, and Wisconsin.

Two different reporters contacted me on my opinion of the study.   One aspect that I had not read yet was that North Carolina was one of the lagging states in providing Workers Compensation medical treatment. (wow!)  I decided to read more into  the study.

nurse taking workers compensation medical treatment blood pressure
by StockUnlimited

Page 17 of the study (flash report) shows the average of all the states.  The table (Table A-2) shows the comparison across all medical treatment types with the 18 studied states.

The states that were the slowest in providing medical treatment were (overall):

  • Massachusetts
  • North Carolina
  • Louisiana
  • California

I am not sure exactly what to draw from the study and flash report. California with its utilization review process would make the delays almost understandable. I am not so sure about the other three.

Our HQ state – North Carolina – surprised me quite a bit.  North Carolina has employer-controlled  worker compensation medical treatment.  North Carolina did not place last or near the bottom in all of  the study’s categories. I will likely need to read the study again to see if any hidden data nuggets exist in the workers compensation medical treatment data.

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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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