Six States Had Surprising Medical Costs Per Claim Increases
The medical costs per claim increase exceeded 12% in six states. WCRI (Workers Comp Research Institute) released its great CompScope Study and Report two weeks ago. Yes, I am running a little late on getting this one into an article.
Looking for the anomalies can be easily accomplished using the CompScope Benchmark Report. WCRI had pointed out that medical costs rose 5 – 12% per claim. If one looks at the chart below, the top six percentage increase states are (highest listed first)
- Louisiana
- Kentucky
- Pennsylvania
- Arkansas
- New Jersey
- Delaware
After reading through some of the CompScope study reports, I could find very little that would be the root cause of the medical costs per claim increases in each state. I think that the statement below from WCRI, which was released with the reports, explained the increases very well.
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“Medical payments per claim remained relatively stable, but recently, they started increasing, fueled by an increase in medical utilization, medical prices, and updates to state fee schedules,” said Sebastian Negrusa, WCRI vice president of research.
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If I were going to estimate which one of the three factors Sebastian mentioned above, medical utilization would likely be considered the main driver of costs. I decided to look at the Pennsylvania CompScope as it was one of the states with the largest medical payments per claim increase.
No exact cause was noted – more of a combination of the three mentioned by Sebastian in his above comment.
The utilization increase could have resulted from injured workers not pursuing medical care during the pandemic. J&L saw that in so many of the claim files we reviewed from 2020 – 2023 that injured workers flat refused to attend medical appointments. Did those refusals fade in 2023, resulting in spikes in utilization? I did not read all of the CompScope Benchmark Studies, only Pennsylvania.
Will medical costs per claim keep increasing next year? To obtain a copy of the 2025 CompScope studies, please go here.
