A recent study by the Workers’ Compensation Research Institute (WRCI) regarding the Illinois workers’ compensation system is worth paying attention to for all interested stakeholders across the United States. The findings of the study highlight the need for claims management teams to not only be proactive in their approach to claims, but engaged with state policymakers regarding the direction of their system. By taking these steps, programs can reduce costs in their programs and ensure injured workers receive the medical care and treatment they deserve.
WRCI Study Overview
The CompScore™ report reviewed areas concerning medical payments, prices and service utilization of the Illinois workers’ compensation program compared to 17 other states. It also analyzed how medical payments changed over time through 2016.
According to the study findings, the following conclusions were reached related to the Illinois workers’ compensation program:
- Payments per claim were higher than the median of all other study states from 2013 through 2015;
- During this same time frame, medical payments per claim grew an average of 3.1%;
- While Illinois had a lower price paid on claims for non-hospital medical services (patient evaluation and office visits), costs were higher for other medical services. This included the price paid on surgical and other professional medical services; and
- Medical costs continue to be a significant driver in workers’ compensation claims. Areas that were identified as leading to this were medical utilization factors, which included more visits per claim and services performed by health care professionals per visit.
Reducing Work Comp Costs Via Proactive Claims Management
There are many lessons proactive members of the claims management team can learn from the WCRI report regarding workers’ compensation claims in Illinois. This should serve as a reminder for those seeking to make a difference that good claims management skills require one to be proactive on all files.
- Medical treatment parameters. Proactive claims management teams need to aggressively use these rules to minimize costs. This includes asking an independent medical examiner to review and provide a professional expert opinion on the care received. It is also important to receive comment on what care, if any, exceeded the medical treatment parameters;
- Medical fee schedules. Claims management teams should regularly conduct internal audits to determine if medical care is being reimbursed via the applicable medical fee schedules. Failure to do so can result in paying more than required, which reduces the effectiveness of a program and the bottom line;
- Using litigation as a settlement tool. Workers’ compensation claims sometimes languish, which results in excessive and unnecessary costs to a program. Claim handlers and others on the team need to be proactive and look for opportunities to place matters into litigation to force settlement discussions. All affirmative defense must be made in good faith. It is also important to remember that simply calling the injured worker or their attorney regarding settlement may be all it takes to resolve an ongoing claim.
Reducing Work Comp Costs Via Public Policy Engagement
The findings of the WCRI report demonstrate the importance of engagement by interested stakeholders with lawmakers and state program regulators. Not being involved in the public square can result in increased workers’ compensation costs. Workers’ compensation fee schedules and treatment parameters serve as the basis for reimbursement and treatment available to cure and relieve the effects of a work injury. The impact on the cost of medical claims becomes noticeable in jurisdictions with reimbursement is noticeable in Illinois based on the following study findings:
- Higher than average medical payments; and
- Higher than average provides paid for professional medical services.
The recent WCRI report highlights ongoing areas of concern in Illinois and across the country when it comes to growing workers’ compensation costs. Proactive stakeholders seeking to reduce workers’ compensation costs need to be engaged in their file load and within the public square to run effective programs.
 States reviewed included: AR, CA, FL, GA, IN, IA, KY, LA, MA, MI, MN, NJ, NC, PA, TX, VA, and WI.
Access the above reference study and learn more about WCRI: https://www.wcrinet.org/reports/compscope-medical-benchmarks-for-illinois-18th-edition
Author Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.
Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/
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