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Comp pays more than group health on similar medical services

Posted On: Sep. 17, 2021 1:23 PM CST


Workers compensation insurers pay more for medical services than that of group health to treat comparable injuries, according to a research report released Friday by the National Council on Compensation Insurance.

In examining the workers comp experiences from NCCI’s medical data call, which captures transaction‐level detail — service, charges, payments, procedure codes and diagnosis codes — on medical bills processed on or after July 1, 2010, for 35 states, researchers found that costs for chronic injuries in comp are 235% higher and 160% higher for acute injuries. 

Specifically, acute “traumas to arms and legs consistently have smaller cost and utilization differences in WC, while chronic pain-related injuries, such as bursitis and back pain,” have larger differences, according to the report.

Also, a more expensive mix of procedures in complex workers compensation cases contributes to higher costs relative to group health, especially for referral-based care, such as radiology and surgery, according to the report.

For the acute injuries, quantity of services accounts for nearly 90% of the entire cost differential between workers comp and group health and for chronic injuries, differences in quantity account for four‐fifths of higher comp costs, according to the report.