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Workers’ Comp Professionals Share Challenges

Workers’ Comp Professionals Share Challenges

At the mid-year point between the 2018 and 2019 National Workers’ Compensation and Disability Conferences, the predictions made by several workers’ comp professionals are still relevant.  Risk & Insurance Magazine queried 512 of these professionals to discover the trends that are important to them, as well as the challenges they believe lie ahead.

The respondents, predominantly risk and claims managers working for insurance carrier/payers or employers, also included clinical providers, TPAs and brokers.  The following comprise what they identified were their Top 10 Challenges for 2019:

  1. The Rising Cost of Care — Close to half of the respondents identified escalating medical costs as the greatest challenge facing their workers’ comp programs in 2019 and beyond. Cost containment is a top priority for all respondents, said the report, noting that the cost of healthcare in the U.S. continues to be unsustainably expensive. “According to the Centers for Medicare & Medicaid Services, healthcare spending will grow around 5.5 percent per year between 2017 and 2026 — outpacing GDP growth by 1 percentage point. In 2026 total spending is projected to hit $5.7 trillion.”
  2. Comorbidities and Poor Worker Health — Aging workers, along with the rising incidence of obesity plays a role in the greater incidence of co-morbidities, noted the respondents. Excess weight, diabetes, hypertension, sleep apnea, joint pain and other conditions that develop as a result of lifestyle factors or age can make recovery much more complicated. “Claims managers in particular were acutely concerned about the impact of comorbidities,” said the report. workers'comp-coverwallet
  3. Opioids — The report noted that the opioid crisis in America is a full-blown public health crisis, but the impact is “even more acute in workers’ comp since nearly every claim has a pain component, and addictive painkillers have long been prescribers’ go-to when treating chronic pain.” Respondents across the board said that managing opioid and other substance abuse issues will be among their main hurdles. The report cites CDC figures: The U.S. prescribing rate for opioids was 61 prescriptions per 100 persons in 2016. NCCI data shows that injured workers were prescribed opioids at three times that rate.
  4. Mental Health Exposures—The complexity around the compensability of mental injuries has mainly concerned post-traumatic stress disorder suffered by police, firefighters, EMTs and other first responders, notes the report. From a workers’ comp perspective, work-related stress and anxiety are more difficult to define and diagnose, but the frequency of claims alleging that unreasonable stress at work premeditated a physical injury like a heart attack is on the rise, notes the report.  In addition, the report states that more than 50 percent of injured workers experience clinically-related depressive symptoms at some point, especially during the first month after the injury.
  5. Growth of Complex Claims — Complex claims come in all shapes and sizes, and the issue is often delayed recovery. Some are complex because of co-morbid or underlying, unrelated medical conditions, some because of psychological issues, some because of employment/performance-related issues, and some because of the severity of the injury. Each of these complexities presents challenges to claim resolutions, notes the report.
  6. Regulatory and Legislative Issues — several national and state legislative updates have the potential to change the way workers’ comp providers and payers do business. Through the first half of 2018 alone, the NCCI tracked 814 state and federal workers compensation bills, 76 of which became law by the end of June, as well as 197 proposed regulation changes, 83 of which were adopted. Most pertained to medical fee schedules and treatment guidelines, says the report. CMS is expected to update coding and document requirements and is also proposing major changes to the Medicare Fee Schedule Evaluation and Management reimbursement model for office and outpatient services.  Respondents also listed medical marijuana as an issue to watch in terms of the debate over whether works’ comp insurers should pay for treatment of claimants using a substance that is still classified a Schedule I drug.
  7. Distracted Drivers and Auto Collisions—Respondents of the Risk & Insurance survey noted that distracted driving, chiefly by commercial drivers and employees who drive regularly as part of their job or use a company car represent a growing percentage of workers’ comp claims. An injury from a motor vehicle accident can cost around $150,000, and a fatality as much a $3.6 million, says the report. Further, data collected from the U.S. Bureau of Labor Statistics (BLS) and the National Academy of Social Insurance indicates that injuries from auto collisions cost employers $3.2 billion per year.
  8. Claims Data Breach—The growing number of cyber attacks is of grave concern among the workers’ comp professionals answering the survey, most notably because if claims data is unlawfully accessed, the breach could violate HIPAA as well as non-health-related privacy protections. For example, notes the report, last year, Oregon’s State Accident Insurance Fund Corp., the state workers’ comp insurer, fell victim to a phishing attack that compromised the information of 1,750 people, including Social Security numbers in some cases.  Breaches require notification obligations, and, as in the case of the Oregon state fund, provision of free credit monitoring for any account that may have been impacted. If any medical records are involved, there could be further fines or legal action, a costly remediation.
  9. Cumulative Trauma (CT) — Soft tissue musculoskeletal injuries (typically from overuse or poor ergonomics) are a major challenge, noted the survey respondents. California, for example, has seen CT claims grow by 50 percent over the past decade, according to WCIRB, a California-based research and advisory firm. CT injuries require more time to heal and are related to higher medical costs. Over their lifespan, CT claims end up being 15 percent more expensive than an average specific injury claim, notes the report.
  10. Litigation Management—-Going to court is can dramatically drive up claim cost. Several attendees emphasized the importance of communication in managing expectations and assuaging claimants’ fears. “Ultimately, improving communication for everyone involved should lead to an improved experience for all and more timely care,” commented one respondent in the report.


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