Waltham, MA – August 7, 2025 — A new study from the Workers Compensation Research Institute (WCRI) examines the key factors associated with high-cost workers’ compensation claims involving back and shoulder injuries, where medical expenses exceed $65,000 within 36 months of injury.

“In a previous WCRI study, we identified factors that increase the likelihood of high medical payments by looking at all injury types together,” said Sebastian Negrusa, WCRI’s vice president of research. “This new study refines that analysis by focusing on back and shoulder injuries to better understand what contributes to higher claim costs.”

The study looks at four back conditions (neurologic back pain; disc disorders; degenerative back conditions; and sprains, strains, and non-specific pain) and three shoulder injuries (rotator cuff disorders, frozen shoulders, and shoulder osteoarthritis).

Key questions the study explores include the following:

  • How prevalent are high-cost claims for these injuries, and how do they compare in terms of medical costs and duration of temporary disability
  • What characterizes high-cost claims versus other claims within each injury category?
  • What factors are associated with elevated medical payments?
  • How do degenerative conditions and comorbidities influence treatment choices and affect costs?

The analysis is based on about 194,000 workers’ compensation claims with more than seven days of lost time, from 32 states. These claims involve injuries that occurred between October 1, 2015, and March 31, 2019, with detailed treatment and billing data tracked for up to 36 months after the injury, through March 31, 2022.

The full report, Patterns and Trends of High-Cost Claims Involving Back and Shoulder Injuries, is authored by Dongchun Wang, Kathryn L. Mueller, and Randall D. Lea. It is available to WCRI members and can be purchased by nonmembers at www.wcrinet.org.

ABOUT WCRI

The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Waltham, MA. Organized in 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand.