Adverse Surprises in Workers’ Compensation: Cases with Significant Unanticipated Medical Care and Costs

By Richard A. Victor

June 1, 2005 Related Topics: Medical Costs, Other

Workers’ compensation cases that evolve into “adverse surprises—cases that have significant, unanticipated medical costs—are a “lose-lose” proposition for both workers and their employers. For an injured worker, receiving substantially more medical care than previously anticipated may indicate that the worker’s health did not improve as expected, and may even have deteriorated. For employers, higher than expected medical costs places a greater burden on their resources and may affect the creation of new jobs and profitability.

Twelve large and geographically diverse states were included in the study: California , Connecticut , Florida , Illinois , Indiana , Louisiana , Massachusetts , North Carolina , Pennsylvania , Tennessee , Texas and Wisconsin . These states have diverse system features and include those that ranked high, medium and low in terms of overall average cost per claim.

Adverse Surprises in Workers' Compensation: Cases with Significant Unanticipated Medical Care and Costs. Richard A. Victor. June 2005. WC-05-16.

Copyright: WCRI

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Research Questions:

1. How do frequency and costs of "adverse suprise" cases vary across states?

2. How has the frequency and costs changed over time?

3. What attributes of cases are associated with the interstate variations and trends?

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