Workers' Compensation Claims Management An Evidence-Based Approach to Measuring, Predicting, and Controlling Costs

Xuguang (Grant) Tao, MD, MS, PhD
Nimisha Kalia, MD, MPH, MBA
Edward J. Bernacki, MD, MPH

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This is the first book of its kind to take a statistical approach to controlling workers' compensation costs. Based on more than 15 years of research on workers' compensation claims costs, Workers' Compensation Claims Management provides the methodology necessary to correctly measure, compare, and predict claims costs for dynamic cohorts. The authors introduce the intervention methods needed to control costs, including cost effective pain management, cost effective injury treatment, and the cost effectiveness of on-site clinics, as well as the use of scientific research in support of controlling costs.

Use this book:

  • When you want to know the performance of your workers' compensation system compared to other systems;
  • When you want to know the performance of your workers' compensation system compared to previous years in the same system;
  • When you want to know how much future open claims in your inventory would cost.

Find answers to questions such as:

  • What are the common mistakes that should be avoided when measuring and comparing workers' compensation claim cost?
  • How to correctly measure and compare workers' compensation claim costs for dynamic cohorts?
  • Are workers' compensation claim costs predictable and how?
  • What are the interventions workers' compensation managers can use to control costs?

No other book describes how to predict workers' compensation claim costs. This is the first book to take a statistical approach to controlling workers' compensation costs. Statistical examples are introduced in plain words with examples. The book will be especially useful for workers' compensation managers in understanding the mixture of claims in a dynamic cohort. It provides the tools needed to deal with the complexity of controlling workers' compensation costs. Data examples are included for readers to practice the methods explained in the book.

Use Workers' Compensation Claims Management to correctly measure, compare, and predict workers' compensation costs and return-to-work based on evidence collected from real data.
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The central tenet of workers' compensation in the United States is that industrial accidents occur as a byproduct of performing tasks assigned by employers. Employers assume the responsibility to pay for the medical care and lost time associated with these accidents. Unlike major medical insurance, the employer's responsibility for medical payments lasts until the claimant reaches maximum medical improvement and the claim is settled. Increasingly, because of the secondary payment requirements of Medicare, many self-insured employers choose not to settle the medical portion of claims but rather continue to bear responsibility for medical payments associated with the injury through the lifetime of the injured employee. Almost universally, compensation is paid both in the form of wage replacement for the period in which the individual was totally disabled and in the form of a lump sum payment for any residual permanent partial impairment once the individual has reached maximum medical improvement. In some instances, the injured worker fails to return to work and the employer is required to pay for wages lost due to the disability for the lifetime of the injured worker.

We have noticed that mistakes are frequently made in reporting and comparing workers' compensation cost outcomes. Consequently, the results are sometimes misleading because of fundamental flaws in methodology. This book hopes to address these flaws.

Currently there is no other book that is devoted to measuring and comparing disability and cost outcomes over sustained periods of time among dissimilar cohorts. This book will serve to introduce the reader to the Johns Hopkins (JH) University and Health System's approach to workers' compensation claims management backed by our 15 years of research. The JH Division of Occupational Medicine utilizes a unique approach to assess claims over a multi-year period and across different workers' compensation systems to predict ultimate workers' compensation claim costs early in claim development.

This book systematically teaches readers to correctly measure, compare, and predict the workers' compensation cost and return to work outcomes based on evidence collected from real data. The concepts and complexities of dynamic workers' compensation cohorts are described in detail. Possible interventions are discussed in order to control adverse workers' compensation claim development. Instructions and electronic data are provided for readers to practice some of the analytical techniques introduced in the book. Readers will be able to measure, compare, and predict the workers' compensation cost and return to work outcomes with the skills that have been introduced in this text.

This book contains nine chapters and two appendixes. Chapter 1 is an introduction to the workers' compensation system; Chapters 2 to 4 deal with the methodology for measuring and comparing workers' compensation claim cost in dynamic cohorts as well as a discussion about the evidence- based predictive modeling tool. Chapters 5 to 7 are introductions to various interventions that may be employed to control costs; Chapter 8 is a summary of key insights from our 15 years of workers' compensation research; and Chapter 9 presents some of the strategies used in the Johns Hopkins Workers' Compensation Program (JHWCP) so that readers understand what we have presented in the book. Appendix I provides instructions for using data contained in Appendix II, an online Excel file containing data for cost-monitoring calculation.

Hopefully, this book fills a void in understanding the complex world of workers' compensation. It is our desire that the book is on the reading list for adjusters, case managers, occupational health professionals and safety officers, or anyone who is interested in understanding the impact of time and claim mix on ultimate workers' compensation claim costs.
Xuguang (Grant) Tao
Nimisha Kalia
Edward J. Bernacki
Table of Contents
About the Authors
(Tao, Kalia, & Bernacki)
CHAPTER 1. History and Description of the Workers' Compensation System
(Kalia & Bernacki)
CHAPTER 2. Measuring and Comparing Workers' Compensation Claim Cost
(Tao & Bernacki)
CHAPTER 3. Risk Factors Associated With Workers' Compensation Cost and Return-to-Work Outcomes
(Leung & Tao)
CHAPTER 4. Evidence-Based Prediction of Workers' Compensation Cost and Return-to-Work
CHAPTER 5. The Evolving Role of Opioids in Workers' Compensation
CHAPTER 6. Workplace Onsite Clinics
CHAPTER 7. Cost-Effective Injury Treatment
CHAPTER 8. Key Insights from 15 Years of Workers' Compensation Research
(Bernacki & Yuspeh)
CHAPTER 9. The Johns Hopkins University Workers' Compensation Program Overview
(Kalia, Lavin, Kraus, Barry)
APPENDIX I. Instruction for Using the Simulated Data Corresponding to Chapter 2 (Tao)
Publication Date 2019
Format Softcover, 216 pages
ISBN 978-1-883595-80-7
Product Code 23601
Price: $85.00 Buy E-Book