An Alternative Grouping of Complex Conditions in Workers’ Compensation

By Dongchun Wang, Randall Lea, M.D., Sebastian Negrusa

June 18, 2024 Related Topics: System Review, Other

There is anecdotal evidence that more serious and complex injuries lead to higher medical costs, longer duration of disability, and suboptimal outcomes. Examining this relationship necessitates a more specific injury classification. Despite previous efforts to classify injuries and illnesses with the goal of facilitating injury research and outcome predictions, injury classifications that are clinically meaningful and sufficiently granular are still lacking.

To address this gap, we developed an alternative injury grouping by considering the more common injuries in workers’ compensation claims and by focusing on injuries that have a higher variability in terms of outcomes. We then examined medical payments, indemnity benefits, and disability duration, as well as the utilization of key medical services on these claims. This grouping allows us to provide insights into the costs and key services associated with these claims, and it paves the way for more narrowly condition-focused studies in the future.

The data used for this study come from claims with more than seven days of lost time, from injuries occurring between October 1, 2015, and September 30, 2019, across 28 states representing more than 75 percent of the U.S. insured workforce.  

An Alternative Grouping of Complex Conditions in Workers’ Compensation. Dongchun Wang, Randall D. Lea, and Sebastian Negrusa. June 2024. WC-24-19.

Copyright: WCRI

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Research Questions:

▪ What are the specific injury categories for complex claims common in workers’ compensation?

▪ How are claims with specific injuries associated with medical payments, indemnity benefits, and disability duration?

▪ How are claims with specific injuries associated with key medical services?

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