The cost of personal injuries claims in New Zealand by claimant characteristics. Nick Allsop David Gifford Chris Latham Noeline Woof

Transcription

1 The cost of personal injuries claims in New Zealand by claimant characteristics Nick Allsop David Gifford Chris Latham Noeline Woof November 2004

2 Overview A description of the benefits provided under the ACC scheme Claim profile by account Variations in cost by type of benefit Relationships between costs and claimant characteristics Claimant characteristics are based on active claimants in the year to 30 June Claim costs are those derived by PwC as ACC s actuaries and relate to the 2004/2005 accident year (AY05). 2

3 ACC accounts Personal injury suffered as a result of an accident Accident Cause Accident Occurred at work Accident is the result of a car accident Injury is the result of medical mishap / error Other Work status of claimant Working Not working Account Work Account (EM + SE + PP) Motor Vehicle Account (MV) Account (MM) Earners Account (EA) Non Earners Account (NE) The account structure is primarily for funding and IP purposes Claims management is the same for all accounts 3

4 ACC benefits Non-fatal weekly compensation (limited to 80% of preinjury earnings; 1 week excess applies) Fatal weekly compensation (paid to the spouses and dependants of deceased claimants; limited to equivalent non-fatal weekly compensation levels) Treatment (medical, ambulance & hospital costs, costs for social rehabilitation, vocational rehabilitation, hospital rehabilitation and other rehabilitation) Lump sums (based on impairment percentage under AMA guidelines; impairment must exceed 10%) 4

5 Claim profile - employment status Motor Vehicle Earners Work Non Earners Total Employed # 80,380 73,885 1,740 12, ,710 Employed % 99% 97% 46% 69% 0% 67% Potential # ,919 12,564 Potential % 0% 0% 1% 3% 16% 5% Not Employed # 806 1,994 2,039 5,234 61,607 71,680 Not Employed % 1% 3% 54% 28% 84% 28% Total 81,217 75,932 3,800 18,438 73, ,954 Earners, Work and Non-Earners accounts are consistent with the account definitions Potential workers are those who, but for their accident, could reasonably have been expected to find employment (e.g. students) Gender splits also affects the employment profile 49% of the NZ population are classified as employed 5

6 Claim profile - gender Motor Vehicle Earners Work Non Earners Total Males - # 50,145 59,497 1,478 11,155 32, ,415 Males - % 62% 78% 39% 61% 44% 61% Females - # 31,033 16,395 2,319 7,174 41,420 98,341 Females - % 38% 22% 61% 39% 56% 39% Total 81,178 75,892 3,797 18,329 73, ,756 49% of NZ population is male, 51% female Males undertake higher risk recreational activities Higher proportion of males in riskier occupations Birth complications in account High accident rates for young male drivers Higher proportion of females are not in employment 6

7 Claim profile - age (participation) Age Band Total claimants Total population Participation Rate 0 to <10 16, , % 10 to <20 33, , % 20 to <30 40, , % 30 to <40 44, , % 40 to <50 43, , % 50 to <60 33, , % 60 to <65 12, , % , , % Total 252,756 3,992, % 45% of population receives an ACC benefit in any year 6.3% receive a non-medical only benefit Participation is lower in younger and older age bands 7

8 Claim profile - age Motor Vehicle Earners Work Non Earners Total 0 to <10 1% 0% 10% 7% 19% 7% 10 to <20 10% 4% 4% 20% 26% 13% 20 to <30 24% 13% 10% 24% 8% 16% 30 to <40 24% 20% 16% 19% 8% 17% 40 to <50 22% 24% 18% 15% 5% 17% 50 to <60 15% 21% 18% 9% 5% 13% 60 to <65 4% 7% 7% 2% 4% 5% 65+ 2% 11% 17% 5% 25% 12% Total 100% 100% 100% 100% 100% 100% Average Age Older average ages in Work and accounts High Motor Vehicle casualty rate in young drivers (mostly male) Young and old claiming under Non-Earners 8

9 Claim profile - serious injury Serious Injury Profile Earners Work Motor Vehicle Non Earners Total Not Serious 99.35% 99.64% 95.50% 92.88% 99.08% 98.83% Serious 0.65% 0.36% 4.50% 7.12% 0.92% 1.17% Of those which are serious: Comparable Diag 4% 13% 11% 3% 5% 5% HL Tetraplegic 17% 8% 1% 9% 9% 10% Incomplete Spine 20% 18% 13% 9% 7% 11% LL Tetraplegic 12% 6% 2% 7% 6% 7% Paraplegic 17% 28% 8% 21% 10% 17% Psychiatric 0% 0% 0% 0% 0% 0% Severe Brain Inj 10% 7% 22% 17% 24% 16% Severe/Mod Brain 20% 20% 43% 35% 39% 32% Total 100% 100% 100% 100% 100% 100% Note: HL = High Level, LL = Low Level Majority of Serious Injuries in Motor Vehicle and accounts Severe to moderate brain injuries are the most common Most Serious Injuries in the Earners, Work and Motor Vehicle accounts are spinal 9

10 Claim profile - injury type (diagnosis) Injury Diagnosis Earners Work Motor Vehicle Non Earners Total Injury and Poisoning 72,944 46, ,344 63, ,552 Hearing Loss , ,001 Infectious & parasitic & respiratory d 750 4, ,752 OOS, pain syndromes, dermatitis, he 1,672 3, ,007 Mental disorders 1, ,381 8,189 Fatal/Other/Undefined 3,173 2,727 3,093 1,909 2,551 13,453 Total 81,217 75,932 3,800 18,438 73, ,954 Injury and Poisoning 90% 61% 14% 89% 86% 79% Hearing Loss 1% 25% 1% 0% 1% 8% Infectious & parasitic & respiratory d 1% 6% 2% 0% 0% 2% OOS, pain syndromes, dermatitis, he 2% 4% 1% 1% 1% 2% Mental disorders 2% 0% 0% 0% 9% 3% Fatal/Other/Undefined 4% 4% 81% 10% 3% 5% Total 100% 100% 100% 100% 100% 100% Mental disorders in Earner and Non-Earner accounts (criminal acts) Hearing loss in Work accounts (industrial deafness) Data issues lead to most diagnosis information being unavailable 10

11 Variation in costs - non-fatal WC Account Ptype=Weekly Non Fatal Earners Work Motor Vehicle Non Earners Total Projected ID incurred costs for AY05 ($'000) 248, ,480 13,406 57,434 7, ,387 Projected Entitlement Claims AY05 60,030 41,803 2,114 6,564 49, ,770 Projected Weekly Comp Claims AY05 36,266 28, , ,583 Average Claim Size (ent clms) 4,141 6,446 6,343 8, ,733 Average Claim Size (wkly clms) 6,854 9,535 85,125 16,753 15,962 8,696 Participation Rate 60% 68% 7% 52% 1% 43% Roughly consistent with employment status High severity injuries in give high average costs 1 week excess contributes to participation being lower than employment proportion (72%) Return to work while still receiving rehabilitation also contributes to lower participation 11

12 Variation in costs - medical Account Ptype= Earners Work Motor Vehicle Non Earners Total Projected ID incurred costs for AY05 ($'000) 105,922 65,573 3,431 14, , ,507 Projected Entitlement Claims AY05 60,030 41,803 2,114 6,564 49, ,770 Projected Claims AY05 511, ,123 1,971 34, ,298 1,436,441 Average Claim Size (ent clms) 1,764 1,569 1,623 2,146 2,081 1,825 Average Claim Size (med clms) , Claims per Entitlement Claim 852% 582% 93% 530% 1310% 899% Large numbers of medical claims Average medical claims highest in & Motor Vehicle accounts due to severity Non-Earners have highest medical to entitlement claim ratio due to fewer entitlement claims 12

13 Variation in costs - hospital rehabilitation Account Ptype=Hospital Rehab Earners Work Motor Vehicle Non Earners Total Projected ID incurred costs for AY05 ($'000) 69,978 47,133 2,793 14,739 39, ,709 Projected Entitlement Claims AY05 60,030 41,803 2,114 6,564 49, ,770 Projected Hospital Rehab Claims AY05 15,656 9, ,579 8,735 35,522 Average Claim Size (ent clms) 1,166 1,127 1,321 2, ,087 Average Claim Size (hosp rehab clms) 4,470 5,073 10,686 9,337 4,472 4,890 Participation Rate 26% 22% 12% 24% 18% 22% Lower participation in and Non- Earners accounts Average hospital claims highest in & Motor Vehicle accounts due to severity 13

14 Variation in costs - vocational rehab. Account Ptype=Vocational Rehab Earners Work Motor Vehicle Non Earners Total Projected ID incurred costs for AY05 ($'000) 17,687 36, , ,973 Projected Entitlement Claims AY05 60,030 41,803 2,114 6,564 49, ,770 Projected Voc Rehab Claims AY05 9,906 10, , ,716 Average Claim Size (ent clms) , Average Claim Size (voc rehab clms) 1,785 3,537 2,573 7,384 2,325 2,900 Participation Rate 17% 25% 7% 16% 1% 14% Participation levels are consistent with employment proportions Average size highest for Motor Vehicle account due to severity of claims Average size in Work accounts high due to focus of this benefit on this account 14

15 Variation in costs - other rehabilitation Account Ptype=Other Rehab Earners Work Motor Vehicle Non Earners Total Projected ID incurred costs for AY05 ($'000) 12,384 8,047 2,198 10,756 13,445 46,829 Projected Entitlement Claims AY05 60,030 41,803 2,114 6,564 49, ,770 Projected Other Rehab Claims AY05 16,975 10,435 1,585 2,691 23,138 54,824 Average Claim Size (ent clms) ,040 1, Average Claim Size (oth rehab clms) ,387 3, Participation Rate 28% 25% 75% 41% 47% 34% Includes death benefit grants, dental treatment, nonambulance conveyance and other miscellaneous costs High levels of death benefit grants are paid under the Motor Vehicle account A high proportion of Non-Earner entitlement claims arise under Other Rehabilitation 15

16 Variation in costs - social rehabilitation Non-serious injuries Ptype=Social Rehab Non Serious Injury Earners Work Account Motor Vehicle Non Earners Total Projected ID incurred costs for AY05 ($'000) 14,653 36,990 2,880 15,151 46, ,198 Projected Entitlement Claims AY05 60,030 41,803 2,114 6,564 49, ,770 Projected SR Non Serious Claims AY05 12,582 9, ,773 17,397 42,399 Average Claim Size (ent clms) ,363 2, Average Claim Size (sr non serious clms) 1,165 3,932 12,077 5,464 2,674 2,741 Participation Rate 21% 23% 11% 42% 35% 27% Includes care, capital, assessment and other costs High participation in Motor Vehicle account due to claim severity High average cost in Work accounts due to capital costs of workplace modifications 16

17 Variation in costs - social rehabilitation Serious injuries Account Ptype=Social Rehab Serious Injury Earners Work Motor Vehicle Non Earners Total Projected ID incurred costs for AY05 ($'000) 26,015 12,713 12,844 65,852 49, ,478 Projected Entitlement Claims AY05 60,030 41,803 2,114 6,564 49, ,770 Projected SR Serious Injury Claims AY Average Claim Size (ent clms) ,077 10, ,042 Average Claim Size (sr serious injury clms) 906, ,307 1,154,534 1,103,969 1,126,392 1,024,955 Participation Rate 0.05% 0.05% 0.53% 0.91% 0.09% 0.10% Includes care, capital, assessment and other costs Low participation but high average costs Highest average costs in and Motor Vehicle accounts due to severity and the Non-Earners account due to younger ages 17

18 Variation in costs - fatal weekly comp. Account Ptype=Weekly Fatal Earners Work Motor Vehicle Non Earners Total Projected ID incurred costs for AY05 ($'000) 14,760 8, , ,254 Projected Entitlement Claims AY05 60,030 41,803 2,114 6,564 49, ,770 Projected Weekly Fatal Claims AY Average Claim Size (ent clms) , Average Claim Size (wkly fatal clms) 108, ,602 30, , ,186 Similar for most accounts Lower average claim size in account due to fewer dependants 18

19 Cost & characteristics - claim incidence Non Earners Projected Entitlement Claims for FY05 by Account Motor Vehicle Work Earners 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 Incurred claims Based on projected entitlement claims for the 2004/2005 financial year (FY05) Higher claims experienced by the Earners, Work and Non- Earners accounts 19

20 Cost & characteristics - average cost Non Earners Projected Average Claim Size for FY05 by Account Motor Vehicle Work Earners 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 Average Claim Size ($) Based on projected average cost per entitlement claim for the 2004/2005 financial year (FY05) Higher average costs in the and Motor Vehicle accounts due to higher claim severity and lower claim frequency 20

21 Cost & characteristics - incurred cost Distribution of incurred costs Projected Incurred Costs for FY05 by Account Non Earners Motor Vehicle Weekly Compensation Non Fatal Weekly Compensation Fatal and Ambulance Social Rehab Serious Injury Social Rehab Non Serious Injury Hospital Rehab Work Vocational Rehab Earners Other Rehab Lump Sums 0% 20% 40% 60% 80% 100% Low proportion of Weekly Comp in Non-Earners High proportion of Lump Sum in High Social Rehab SI in MV and MM accounts 21

22 Cost & characteristics - incurred cost Total incurred costs Projected Incurred Costs for FY05 by Account Non Earners Motor Vehicle Weekly Compensation Non Fatal Weekly Compensation Fatal and Ambulance Social Rehab Serious Injury Social Rehab Non Serious Injury Hospital Rehab Work Earners Vocational Rehab Other Rehab Lump Sums Incurred cost ($m) High levels of Weekly Comp give the Work and Earners accounts the highest incurred costs costs dominate Non-Earners 22

23 Cost & characteristics - payment runoff Payment pattern by account 60.0% 50.0% 40.0% % paid 30.0% 20.0% 10.0% 0.0% payment years Earners Work Motor Vehicle Non Earners Runoff is slower for Motor Vehicle and accounts High proportion of short duration claims in other accounts 23

24 Characteristics & accounts - Earners Higher proportion of male claimants More entitlement claims than Non-Earners due to weekly compensation 37% of accidents at home, 27% during sport/recreation Younger average age than Work accounts Less vocational rehabilitation than Work accounts Contains 30% of all tetraplegics (mainly from rugby and horse riding) 66% of serious injuries in the Earners account are spinal injuries 24

25 Characteristics & accounts - Work 80% of entitlement claimants male More males injured in industrial sites, females dominate commercial site injuries Hearing loss injuries predominantly male (30% of all male entitlement claims in the year) 52% of active Work claims can be expected to receive weekly compensation Older average age than most other accounts Fewer serious injuries than other accounts (mainly spinal injuries) High weekly compensation proportion 25

26 Characteristics & accounts - Med. Mis. Low frequency, high average cost Includes 47% of all serious brain injuries Low employment proportion due to higher numbers of female claimants Highest proportion of lump sum payments 26

27 Characteristics & accounts - Motor Low frequency, high average cost Includes 44% of all serious injuries (including 40% of all high level tetraplegics & 45% of all severe brain injuries) Younger average age compared to Earners, Work and Non- Earners accounts Highest fatal weekly compensation amounts High proportions of head injuries 70% of claimants employed but only 6% of accident occur at work Males under the age of 20 incur 17% of all Motor Vehicle accidents 27

28 Characteristics & accounts - Non-Earner Very low levels of weekly compensation Dominated by female claimants and claims occurring in the home 60% of male Non-Earner claimants are aged less than 20 Includes 23% of all serious injury claims (includes 30% of all serious brain injuries most of which occur in the home) 11% of injuries occur during sport/recreation, 9% occur at school (mostly to males) High proportion of mental disorders (mainly female sexual abuse claims) 28

29 Conclusions Accounts clearly separated into low frequency/high cost (MM & MV) and high frequency/low costs (EA, Work & NE) Injury severity determines ultimate variation in cost Costs are also affected by claimant characteristics (age, gender, employment status, etc.) in each account Account specific features affect seriousness of injuries and utilisation of benefits Analysis of individual case estimates may show further differences between the accounts 29

30 The cost of personal injuries claims in New Zealand by claimant characteristics Nick Allsop David Gifford Chris Latham Noeline Woof November 2004