Examining Costs and Trends of Workers Compensation Claims

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1 Consulting Actuaries Examining Costs and Trends of Workers Compensation Claims in Connecticut Authors Scott J. Lefkowitz, FCAS, MAAA, FCA Eric. J. Hornick, FCAS, MAAA, FCA

2 Contents 1. Introduction 1 2. Average Claim Costs in Connecticut Introduction Connecticut Claim Costs Benchmarking 4 3. Claim Frequency 6

3 1. Introduction The average cost of workers compensation claims naturally increases over time. Wage inflation has a direct impact on the cost of indemnity (wage replacement) benefits, while increases to the cost of medical services and pharmaceuticals have a highly leveraged impact on the cost of workers compensation claims, where medical care is generally more complex and costly than services associated with general health care. Average claim costs and trends will vary between states. Each individual state has its own workers compensation benefit structure, administrative system, and governing statutes. Compensation rates, maximum and minimum weekly benefits, automatic adjustments to maximum and minimum benefits, system utilization, industry mix, administrative efficiency, constraints on medical care, and general cost of living levels all potentially vary by jurisdiction and represent a sample cross section of items that directly impact variances by state. The purpose of this paper is as follows: Present current estimates of average workers compensation claim costs in Connecticut based on the most recent available data from the NCCI 1 ; Benchmark average Connecticut claim costs against claim costs in other states; and Present current claim incidence rates in Connecticut. Footnote references throughout the paper provide additional detail and context around the text. 1 The National Council on Compensation Insurance is the workers compensation data collecting organization in Connecticut. The NCCI is an extension of the insurance industry and analyzes collected workers compensation claims data generated by all insurance companies doing business in Connecticut. The NCCI uses this data to calculate, among other items, the cost of wage replacement benefits, medical benefits, and claim adjustment expense per unit of $100 payroll for all employee classifications. Individual insurance companies develop their own unique premium rates by factoring insurance company expense and profit provisions. Copyright 2012 Oliver Wyman 1

4 2. Average Claim Costs in Connecticut 2.1. Introduction Lost time and medical only are the two most general categories of workers compensation claims. Lost time claims are sufficiently serious to warrant lost work time of sufficient duration 2 such that the employee qualifies for wage replacement benefits. Conversely, medical only claims are cases where wage replacement benefits have not been and are not expected to be paid. Medical only claims are characterized by minor injuries requiring minimal medical treatment with little or no lost work time 3. Generally, lost time claims represent only 25% of total claim volume, but generate 95% of total workers compensation benefit costs. Conversely, medical only claims represent 75% of total claim volume, but generate only 5% of total workers compensation costs. Claim costs are measured using policy year data 4. Data from policy years 2001 through are currently available for Connecticut claims Connecticut Claim Costs The table to the right displays average lost time claim costs, average medical only claim costs, and average combined total claim costs, by policy year. 6 Of note is the very large difference between lost time claim costs and medical only claim costs. This difference emphasizes how, despite generating the majority of overall claims, medical only claims generate only a very small percentage of overall workers compensation costs. Average workers compensation claim costs Connecticut Policy Year Lost Time ($) Medical only ($) Combined Total ($) , , , , , , , , , , , , , , ,989 1,057 16,502 2 All states have a waiting period for wage replacement benefits that generally range from 3 to 7 lost workdays. Wage replacement benefits are paid only if the disability exceeds the waiting period. The employee is retroactively reimbursed for wages lost during the waiting period only if the disability exceeds a specified duration defined as the retroactive period. 3 Connecticut has a 5 day waiting period and a 21 day retroactive period. Therefore, claims with 5 or less lost workdays are, by definition, medical only claims, as no wage replacement benefits will have been paid. 4 The policy year of experience represents, very roughly, the period during which the claims generating the data occurred. Specifically, the policy year of experience represents claims covered by insurance policies incepting during a specified calendar period, which varies by state. For example, policy year 2008 could represent claims covered by insurance policies beginning during calendar year It is apparent that since most policies provide coverage for a single year, half the claims in this example occurred in calendar year 2008, and half the claims occurred in calendar year This is easily seen by considering a policy beginning on July 1, This policy provides coverage for the last six months of 2008 and the first six months of Policy year 2008 represents the most recently available data. This is because the NCCI must collect, compile, and examine data generated by every insured workers compensation claim in Connecticut. This multi-year lag between collection and publication is common and expected in the insurance industry. 6 The average lost time claim cost is the cost of all lost time claims divided by the number of all lost time claims. The average medical only claim cost is the cost of all medical only claims divided by the number of all medical only claims. The average total claim cost is the cost of all lost time AND medical only claims divided by the number of all lost time claims AND medical only claims. Copyright 2012 Oliver Wyman 2

5 The graphs below show that trends to claim costs have been relatively stable over time, and are approximately 8.0%. Specifically, measured annual trends and claim cost forecasts for 2012 are in the table to the right. claim type annual trend 2012 forecast ($) Lost Time 7.8% 72,520 Medical Only 8.2% 1,475 Combined Total 7.8% 22,267 Average Workers Compensation Claim Costs Connecticut AVERAGE LOST TIME CLAIM COST ($) 80,000 60,000 40,000 20, POLICY YEAR OF CLAIM EXPERIENCE AVERAGE MEDICAL ONLY CLAIM COSTS ($) 1,600 1, POLICY YEAR OF CLAIM EXPERIENCE AVERAGE TOTAL CLAIM COSTS ($) 25,000 20,000 15,000 10,000 5, POLICY YEAR OF CLAIM EXPERIENCE Available policy year data Trend line Policy year forecasts Copyright 2012 Oliver Wyman 3

6 2.3. Benchmarking Average lost time claim costs as well as average medical only claim costs in Connecticut have been consistently in the highest third of all jurisdictions, when benchmarked against other states. This is illustrated by the first two charts below. However, average combined total claim costs in Connecticut have generally been in the top 10 states, illustrated in the third chart below. Average Lost Time Claim Cost Top 10 states by policy year PY 2008 PY 2007 PY 2006 PY 2005 PY 2004 DE 83,013 DE 78,726 DE 79,595 DE 74,173 DE 66,315 LA 77,231 NY 66,501 LA 62,015 LA 58,660 NY 54,007 NY 73,055 LA 65,657 NC 60,748 NC 58,356 NC 53,776 MT 64,773 MT 63,021 NY 60,124 NY 56,424 LA 50,980 NC 63,234 NC 61,963 MT 55,405 MT 54,646 SC 48,141 GA 61,821 VA 57,737 VA 54,142 VA 49,766 GA 47,059 AL 59,905 GA 56,925 GA 52,525 GA 49,623 MT 45,829 AL 59,905 GA 56,925 GA 52,525 GA 49,623 MT 45,829 IL 59,190 IL 55,438 SC 52,376 IL 47,960 IL 44,228 PA 57,492 AL 55,281 IL 50,643 SC 46,734 VA 44,178 CT 52,989 CT 51,985 CT 45,783 CT 43,040 CT 38,220 Average Medical Only Claim Cost Top 10 states by policy year PY 2008 PY 2007 PY 2006 PY 2005 PY 2004 LA 1,709 LA 1,607 LA 1,501 LA 1,424 LA 1,402 AK 1,510 NJ 1,486 NJ 1,410 NJ 1,290 NJ 1,248 NJ 1,509 DE 1,391 DE 1,296 AK 1,280 AK 1,199 NH 1,401 AK 1,367 AK 1,285 IL 1,160 DE 1,141 DE 1,323 NH 1,323 NH 1,209 DE 1,153 IL 1,085 IL 1,307 IL 1,215 IL 1,197 NH 1,108 NH 1,030 VA 1,243 VA 1,160 VA 1,067 VA 1,000 TN 989 IN 1,200 IN 1,097 MO 1,025 FL 949 VA 931 AL 1,178 MO 1,094 AL 1,023 DC 946 AZ 918 WI 1,164 AL 1,081 IN 1,000 MO 940 NM 907 CT 1,057 CT 959 CT 920 CT 881 CT 813 Copyright 2012 Oliver Wyman 4

7 Average Combined Total Claim Cost Top 10 states by policy year PY 2008 PY 2007 PY 2006 PY 2005 PY 2004 NY 27,652 NY 24,431 DE 24,262 DE 22,162 NY 19,771 DE 24,802 DE 23,445 NY 21,939 NY 20,686 DE 19,527 LA 22,060 LA 18,895 LA 17,145 LA 16,875 CA 16,510 IL 19,805 IL 18,381 IL 16,556 IL 15,432 LA 14,630 OK 18,159 OK 16,134 DC 15,983 MT 13,946 IL 14,429 CA 17,433 NJ 16,100 AK 15,471 CA 13,686 AK 14,153 MT 16,791 AK 15,985 NJ 15,263 NJ 13,682 DC 14,007 DC 16,780 MT 15,889 SC 14,776 NC 13,549 NJ 13,613 CT 16,502 CT 15,598 OK 14,337 OK 13,351 SC 13,582 SC 15,532 CA 15,265 CT 14,110 SC 13,185 OK 12,796 CT 13,057 CT 11,965 The question that immediately comes to mind is why would the combined (lost time plus medical only) total average claim costs fall within the top 10 states if the individual component claim costs, when measured separately, are both well below the top ten states. The answer is the relative incidence of lost time cases in Connecticut. On a countrywide average basis, lost time claims represent approximately 25% of all claims, while generating in excess of 95% of all costs. In Connecticut, however, lost time claims have consistently represented approximately 30% of all claims. This is illustrated in the chart below: Lost Time Claims as a Percentage of Total Claims Connecticut Policy year Lost Time Frequency Medical Only Frequency total Frequency Lost Time Percentage ,565 3,863 5, % ,484 3,543 5, % ,725 3,849 5, % ,586 3,733 5, % ,503 3,702 5, % ,471 3,533 5, % ,418 3,525 4, % ,384 3,269 4, % Note: Frequency is measured as claims filed per 100,000 employees Given the chart above, in Connecticut, there is a materially greater percentage of claims that are high cost lost time cases as compared to the countrywide average. Copyright 2012 Oliver Wyman 5

8 3. Claim Frequency The graph below displays the frequency of medical only claims and lost time claims per $10 MM payroll adjusted to a constant cost level. Note that there is an inherent increase to payroll over time due to inflation. In order to accurately measure historical claim frequencies, payroll must be adjusted to a constant cost level. Without this adjustment, historical claim frequencies would be overstated, all else being equal. Claim Frequency per $10 MM Payroll at Constant Cost Level Connecticut CLAIM INCIDENCE PER $10 MM PAYROLL AT CONSTANT COST LEVEL POLICY YEAR OF CLAIM EXPERIENCE Medical only claim frequency Lost time claim frequency It is apparent from this graph that there has been a long term decrease to the incidence of both medical only and lost time claims, which continues in the short term as illustrated in the table below: Claim Type Long Term Annual Trend Short Term Annual Trend Lost Time -2.4% -3.3% Medical Only -3.3% -3.1% Long term annual trend is measured as the average annual decline across all available data. Short term annual trend is measured as the average annual decline across the most recently available 5 policy years of data 2004 through 2008 as of the writing of this paper. Copyright 2012 Oliver Wyman 6

9 About the Authors Scott J. Lefkowitz is a Director of the Actuarial Consulting Practice of Oliver Wyman and Leader of the Melville, New York office. Scott is a Fellow of the Casualty Actuarial Society, a member of the American Academy of Actuaries, and a Fellow of the Conference of Consulting Actuaries. Scott has twenty five years of actuarial experience in the insurance and risk management industry, and has provided consulting services to a wide variety of clients on all aspects of property/casualty risk exposure. Scott is regarded as an expert the area of workers compensation and has provided consulting services to public and private firms, governments, and regulatory agencies. Scott s experience includes ratemaking, and reserving, rate of return analysis, occupational disease, and the design and implementation of experience rating programs. Most recently, Scott has spent the past several years studying New York workers compensation costs, as well as the impact of the statutory changes that were implemented in New York in Scott can be contact directly at (631) or Eric J. Hornick is a a Principal of the Actuarial Consulting Practice of Oliver Wyman and is based in the Melville, New York office. Eric is a Fellow of the Casualty Actuarial Society, a member of the American Academy of Actuaries, and a Fellow of the Conference of Consulting Actuaries. Eric has nearly twenty five years of actuarial experience in the insurance and risk management industry, with previous experience at a rating organization, reinsurance/insurance company and reinsurance broker, and has provided consulting services to a wide variety of clients on all aspects of property/casualty risk exposure. In recent years, Eric s client base has included self-insureds throughout New England, New York and other areas, with a primary emphasis on workers compensation. Professionally and civically active, Eric serves in leadership roles for both the Casualty Actuarial Society as well as local civic groups. Eric can be contacted directly at (631) or

10 The Actuarial Consulting Practice of Oliver Wyman specializes in property, casualty, life and health insurance risks. We provide independent, objective advice combining a wide range of expertise with specialized knowledge of specific risks. With more than 70 credentialed actuaries it is one of the largest actuarial practices in North America. Oliver Wyman currently has actuarial consulting offices in Atlanta, GA; Charlotte, NC; Chicago, IL; Columbus, OH; Houston, TX; Los Angeles, CA; Melville, NY; Milwaukee, WI; New York, NY; Philadelphia, PA; Princeton, NJ; San Francisco, CA; St. Michael, Barbados, and Toronto, ON, Canada. For more information, contact: Scott J. Lefkowitz FCAS, MAAA, FCA Eric J. Hornick FCAS, MAAA, FCA Oliver Wyman Actuarial Consulting, Inc. 48 South Service Road, Suite 310 Melville, NY Copyright 2012 Oliver Wyman. The Actuarial Consulting Practice of Oliver Wyman provides a wide range of consulting expertise to the banking, insurance, and other related industries. The casualty actuarial practice specializes in evaluating the long-term financial consequences of property and casualty insurance risks. The information contained herein is based on sources we believe reliable, but we do not guarantee its accuracy. It should be understood to be general risk management and insurance information only. Oliver Wyman makes no representations or warranties, expressed or implied, concerning the financial condition, solvency, or application of policy wordings of insurers or reinsurers. The information contained in this publication provides only a general overview of subjects covered, is not intended to be taken as advice regarding any individual situation, and should not be relied upon as such. Statements concerning tax and/or legal matters should be understood to be general observations based solely on our experience as risk consultants and insurance brokers and should not be relied upon as tax and/or legal advice, which we are not authorized to provide. Insureds should consult their own qualified insurance, tax and/or legal advisors regarding specific risk management and insurance coverage issues. This document or any portion of the information it contains may not be copied or reproduced in any form without the permission of Oliver Wyman, except that clients of any of the companies of Marsh and McLennan Companies need not obtain such permission when using this report for their internal purposes, as long as this report is reproduced in its entirety, and this page is included with all such copies or reproductions.

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