Managing Mega Losses in Worker’s Comp with the 3 E’s: Expertise, Experience & Embracing Outcomes

Paradigm − June 8, 2018 − filed under Medical Expertise

On May 17, Paradigm’s Chief Medical Officer Dr. Michael Choo and Scott Goll, Senior Vice President, presented on the unique – and rising – category of Mega Loss claims in Workers’ Comp at the National Council on Compensation Insurance (NCCI) Annual Issues Symposium.

Mega losses are defined as claims with total incurred loss greater than $1 million. At Paradigm, we have proven experience with catastrophic injuries including spinal cord, brain injuries, and multiple amputations and severe burns—all of which typically fall into the “mega loss” category.

As Dr. Choo shared during his presentation at NCCI, “Medical innovation is moving at an unprecedented pace. Accounting for the impact of these developments is essential.”

The three biggest contributors to mega loss claims are:

  • Trends in injury survivability. People are surviving accidents that used to be fatal. According to information from the Journal of the American Medical Association (JAMA), the survivability rates for unintentional injuries have increased by 40% since 1978.
  • Rise in life expectancy. Another contributing factor is a rise in life expectancy rates for patients with catastrophic injuries.
  • Treatment costs. New treatments are very expensive, and specialized treatment programs can be very costly.

What’s the solution to managing the rising costs?

According to Paradigm’s Scott Goll, the three key considerations for managing mega loss claims are:

  • Paradigm’s proven approach uses a comprehensive care plan that is developed by the Paradigm Management Team after consultation with treating physicians and others. The approach incorporates nationally recognized, expert physicians, onsite catastrophic and complex pain nurse case managers to coordinate with medical and rehabilitation providers to ensure that the right care is delivered at the right time.
  • Paradigm brings more than 25 years of clinical data to guide decisions and inform action.
  • Embracing Outcomes. By focusing exclusively on catastrophic and complex injuries, Paradigm outperforms the industry by 5x on getting patients back to work, while saving 40% on medical and indemnity expenses.

To learn how Paradigm Outcomes can help improve the lives of injured workers with complex pain, contact us online or call (800) 676-6777. You can also find other case studies on our website.


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