Our friends at Risk & Insurance recently published an article showing the results of a survey they conducted at the 2018 National Workers’ Compensation and Disability Expo in Las Vegas, NV, in which the respondents revealed what they felt would be their top 10 challenges for 2019. The article summarized the responses of 512 attendees, most of which were claims managers and risk managers. You can click here to link directly to their article, but we felt there were a couple of noteworthy issues to mention in our blog.
The two issues we found most compelling were the Growth of Complex Claims coming in at #5, and Cumulative Trauma (CT) claims coming in at #9. These two resonated with us as we often encounter these types of files through our core service offering of helping clients settle their legacy claims, or old dog files. Both types of claims, in our experience, must be given special attention to prevent them from spiraling out of control leading to increased costs and complexities.
As noted in the article, a complex claim does not always start that way. A variety of factors including atypical recovery time, heavy prescription medication use, implanted devices, and psychological developments can all indicate that a particular file may be going down the “legacy path”. They evolve over time due to a variety of factors and quickly reach “complex” status when left unchecked. Our file reviews with clients often indicate that a relatively small portion of claims in a workers’ compensation program are classified as legacy claims, but those few claims represent a large portion of the cost associated with the overall program, so it is imperative to identify trends and make accommodations for amicable settlement discussions.
CT claims, or claims involving an injury resulting from repetitive trauma over a period of time, achieve “legacy status” simply by the amount of time they tend to persist. While the costs associated with CT claims are not always significantly higher than those of a typical workers’ compensation claim on an annual basis, the duration of time from injury to settlement is usually much higher. CT claims, as the article states, often last a decade or more. As with any legacy claim, approaches to settlement of these claims does not always follow a traditional path, so proper consideration must be given to a settlement negotiation.
The Workers’ Compensation Insurance Rating Bureau of California (WCIRB), recently released a report on CT trends in California which we found particularly interesting, and this report can be viewed by clicking here.