November 17, 2015

Costly Answers to Once-Fatal Work Injuries

Claims Management
, Cost Containment
, Patient Management

Catastrophic claims have traditionally been considered to be true to their name, usually the result of a disastrous – and rare – workplace event. However, payors are seeing an increase in the number of catastrophic claims in their programs.

In a recent article in Business Insurance, Stephanie Goldberg reported on this trend, specifically the increasingly complex nature of catastrophic workers’ compensation claims. In her article, this shift is attributed to the growing cost of medical care and that injured employees today are surviving injuries that were considered fatal as early as five years ago, according to experts.

Diane Blaha, Senior Vice President Sales and Marketing at CorVel, and Rhonda Moran, Vice President at CorVel, spoke with Goldberg about other factors that can be attributed to more catastrophic claims in workers’ compensation mixes of claims.

Catastrophic injuries usually require an immediate response, but “acute symptoms of underlying conditions may result in death or significant permanent injury,” said Diane Blaha, Chicago-based senior vice president at claims and managed care services provider CorVel Corp.

“It could be that (an injured worker) fell off the cart in the emergency room and lost consciousness, they were given the wrong dose of medication, or they had a bad response to the medication,” Ms. Blaha added.

The article discusses how medical and technological advances in the industry enable injured workers with complex injuries the ability to survive, which they may not have been able to do so in the past. Not only do patients survive catastrophic workplace injuries, but they are also able to return to productive life and often their jobs.

Blaha spoke to how return to work is being made a possibility:

“What we're able to do today with mechanics and robotics is amazing,” Ms. Blaha said. “Yes, it's going to cost you a whole lot more from a medical expense (standpoint), but you are getting these people back to work, which five, 10, 15 years ago you didn't see.”

She said that most employers do whatever it takes to return injured employees to work and to productive lifestyles, as “the cost of that medical care is going to be less than supporting (an injured worker) for the rest of their life.”

Blaha outlines one of the concepts associated with a successful medical management program is investing in upfront costs for care, which pay off in the long run. To learn more about this concept, read CorVel’s whitepaper “The Value of Case Management.”

One area that does need attention in regards to catastrophic claims are the employees who witness the catastrophic injury occurring. Just because they are not the physically injured worker, they are still affected, according to Blaha.

“What happens to the employees that are left at the job site?” Ms. Blaha said. “(They're) working together and witness (someone) crushed between a truck and a wall as it's backing up. (They) witness (a worker) jumping or falling off a building during construction.”

“Think about the people left at a job site that have witnessed the catastrophic injury,” she said, noting that they might develop post-traumatic stress disorder. “This is where we find employers aren't prepared.”

Read the entire article and learn more about catastrophic claims in workers’ compensation in Goldberg’s article “Costly Answers to Once-Fatal Work Injuries.”

To learn more about CorVel’s claims management model, including how they manage catastrophic claims, visit their website.