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Medical Only Claims Analysis – Little Claims That Wreck Budgets


Workers Comp Medical Only Claims Analysis – Little Claims Can Explode

I have written about performing a  medical only claims analysis quite often in the past.  Now that I am reviewing more loss runs, I still see a pattern that may make you rethink your worker’s comp loss run reviews.  Festering tiny claims often fly under the radar.

Check out this article on how a $400 medical only claim became a $1,000,000 claim in today’s dollars to see why your medical only claims analysis may prevent a huge claim.

pic of nuclear bomb explosion medical only claims analysis
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Adding in a Medical Only Claims Analysis  – Five Suggestions

The most important step is establishing a workers comp medical network that will provide your injured employees with the best medical care possible that will return them to gainful employment.

These steps can be accomplished easily by tracking them using a simple Excel spreadsheet.  Review your loss runs (medical and lost time claims) at least monthly.

  1. Stop analyzing the medical only claims like they are lost time unless the claims have an Indemnity Reserve open with no benefits paid to date.
  2. Set a maximum medical only claim value – for instance, $10,000.
  3. Set a length of treatment maximum claims value – for instance, one year.
  4. Do not ignore the small medical only claims – the ignored claims can turn into the most costly ones.  You may not want to email the medical only adjuster on every little claim.   Track the claims as they progress using your Excel spreadsheets as part of your medical only claims analysis.
  5. Email the medical only claims adjuster with an inquiry when the reserves exceed the values in #2 or the time limit in #3.  Check with the adjuster at least every 90 days on the claims with excessive values.
  6. Bonus – Status inquiries on any claim are best done by email.  Check out this article on why emails are recommended for contacting any claims staff.

Online Claims Access Saves Time and Effort

If you have obtained online claims access, and you should for all your claims,  you may be able to not have to contact the medical only adjuster.  The claim notes may provide an explanation as to the excessive reserve values or why the medical only claim has stayed open past the one-year mark.

Related: Workers Comp Medical Inflation



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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