Creeping Work Comp Claims - Identify and Manage Them Part One

Written by on 8/9/2017 2:53 AM in , , . It has 0 Comments.

How do seemingly ‘average’ work comp claims balloon into long-term medical treatment and disability cases? Dubbed ‘creeping catastrophic’ or ‘developmental’ claims, these aren’t serious injuries, brain/spinal cord issues or death claims. These claims start out as run-of-the-mill issues: Back, knee or shoulder injuries… Which following a series of events, accumulate to the tune of hundreds-of-thousands of work comp dollars.

How to Spot Creeping Claims
Developmental work comp claims share common characteristics, with timely attention the key factor in thwarting their
adverse effects. Common factors include:

Unnecessary Disability
There's a strong correlation between claim duration and the chance of
returning to work. Are you keeping up with injured workers? Those disabled longer than 6 months have a 50/50 chance of returning. Those out longer than a year – less than 10%

Inappropriate Treatment
Incorrect diagnosis and inappropriate treatments prolong recovery and skyrocket costs. A number of factors drive this issue: Misdiagnosis, financial incentives to over-treatment, higher reimbursement rates compared to Medicare/group health, lack of deductibles for care, and the quest for settlements.

Psycho-Social Issues
While you cannot control the motivation of injured workers, you can look for these red flags for difficult cases:

  • Disabled spouse

  • Young children in the home

  • Drug/alcohol dependence

  • High school education (or less)

  • Low wages

  • Discipline problems

  • Psychosocial issues (depression)

  • Co-morbidities
    Claims with co-morbidities - obesity, hypertension, diabetes – cost twice those of comparable claims.

  • Opioids
    Studies show disability duration of those on opioids 50% higher than comparable claims.

Now you know how to ferret out creeping work comp claims, learn how to manage them. Stay-tuned for more from your friends at Minnesota Comp Advisor in part two of this series.

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