Workers Compensation Burn Injuries—Catastrophic Claim Management—What’s New

National Council on Compensation Insurance (NCCI)

Authors: Michael Choo, MD, MBA, FACEP, FAAEM, Chief Medical Officer and Senior Vice President at Paradigm and Victor Wong, ACAS, MAAA, Actuarial Consultant at NCCI

Introduction
The rising cost of healthcare in the United States may be considered as one of the top dilemmas for our nation. In recent years, the workers compensation (WC) industry recognized that medical costs now account for almost 60% of total claim costs and are outpacing indemnity costs. Juxtaposed against this trend is the emergence of mega‐loss claims from severe burn injuries, with medical costs exceeding many millions of dollars early in the claim’s development. To gain insight into some of the contributing factors to the high medical costs associated with these burn‐related mega‐loss claims, the National Council on Compensation Insurance (NCCI) collaborated with Paradigm, an accountable care management organization focused on improving the lives of people with complex and catastrophic injuries and diagnoses. These two organizations highlight some of the key findings in this research brief.

Key Findings
For severe burn injuries, Paradigm and NCCI data indicated: 

• Few fatalities for injured workers occurred each year
• The survival rates for older injured workers improved
• A narrower group of occupations is observed in the majority of burn cases; injured workers with high severity burn  claims tend to come from the manufacturing and contracting industries
• Acute inpatient hospital payments are a key cost driver for the treatment of severe burn injuries
• In recent years, the use of skin substitutes for burn treatment increased
• Many injured workers with high severities develop subsequent physiological and psychological problems
• Return to work is a common outcome, even for injured workers suffering severe burn injuries

Full research brief on ncci.com: Workers Compensation Burn Injuries—Catastrophic Claim Management—What’s New