Top 5 medical costs in workers’ compensation

Each year, the Workers' Compensation Insurance Rating Bureau of California (WCIRB) issues a report on the expenses incurred in workers’ compensation cases in the state. The WCIRB is a nonprofit association of insurance companies who provide workers’ compensation in the state. The latest report just came out.

According to the WCIRB, 60 percent of all workers’ compensation costs were directly for medical treatment. Keep in mind that workers’ compensation also pays for lost wages, vocational rehabilitation and other costs, so the fact that medical expenses are greater than those other costs combined speaks to how expensive proper medical treatment can be.

Workers who have been injured on the job will not be surprised. The cost of medical treatment can rise quickly after a serious injury, which is the reason workers’ compensation benefits are needed so badly.

The five largest medical expenses in workers’ comp claims

According to the WCIRB, the five greatest expenses to insurers are:

  1. Payments made directly to injured workers (28 percent)
  2. Payments to physicians (26 percent)
  3. Hospital bills (12 percent)
  4. Medical/Legal Evaluations (7 percent)
  5. Pharmaceuticals (6 percent)

Other medical costs include lab tests and special services such as radiology, acupuncture and chiropractic work, among others.

Workers’ comp claims require extensive medical documentation

Of note is the amount spent on compiling medical/legal evaluations. In order to be successful on a workers’ compensation claim, the injured worker must see the insurer’s own doctor and compile what can seem like a mountain of medical evidence.

That is one reason why a workers’ compensation attorney is so valuable.

The expense for medical/legal evaluations is not associated with attorneys’ fees: it is what they spend on their own doctors to compile information on every workers’ comp claim. That is what insurers are paying for: to have their own medical evaluations of every claim. And doctors who are getting large sums of money from insurers may not be able to be completely objective about evaluating injured workers.

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