A look at “mega” workers’ comp claims

On Behalf of | Sep 23, 2020 | Workers' Compensation, Workplace Injuries

Regular readers of our Wisconsin Workers’ Compensation Law Blog know that in order to get a full understanding of issues involving on-the-job injuries, we sometimes dive into the ways employers and workers’ comp insurers view the world.

A recent article in an insurance industry publication offered a glimpse into an issue concerning workers’ compensation insurers: “mega” claims.

The Business Insurance report said workers’ comp claims that qualify as “mega” are those that cost insurers at least $3 million.

Medical tech advancements

An analysis of insurer data shows that mega claims are rising – though they still “comprise a statistically small percentage of all workers comp claims” – and are expected to continue to grow in coming years. The mega claim rise is due to advancements in medical technology that enable people to survive significant injuries, and the cost of those advancements.

The article says mega claims current cost insurers more than $2 billion a year.

Data dive

Researchers looked at more than 4,500 mega claims that cost more than $3 million from 2001 through 2017 and found the following statistical facts:

  • 57 percent of the claims were for between $3 million and $5 million
  • 33 percent were for between $5 million and $10 million
  • 10 percent cost workers’ comp insurers in excess of $10 million each

Construction worker injuries

Researchers also found that claims are reaching the $3 million threshold more quickly than in the past. One of the report’s authors said the acceleration of claims to mega status is due in part to an increase in injuries to construction workers — “potentially due to the higher relative hazardousness of the construction industry compared with other industry sectors.”

Unfortunately, one of the ways many insurers and employers try to contain costs is to try to deny workers’ compensation benefits to employees who have sustained workplace injuries or who have work-related illnesses. Workers denied Wisconsin workers’ comp benefits have the right to appeal, however.



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