Claim Severity in Workers Compensation Claims Brendon Frost Daniel Smith
Outline What do we mean by injury severity? Traumatic versus Chronic The modelling Clusters Model results Business insights
What do we mean by injury severity? The degree of injury at the time of injury? How badly injured the worker is? The consequence of an event?
What do we mean by injury severity? (cont.)
Traumatic versus Chronic Practitioners are well aware of the different patterns of medical treatment of claims Traumatic blood on the floor ; immediate medical treatment; treatment runs down as the injury heals Chronic often no initial medical treatment; as the injury deteriorates medical treatment builds up; can lead to surgery several months post accident
Traumatic versus Chronic (cont.) Allocating claims to t, c, or u based on accident type and affliction nature Medical costs tt ct uu cu cc ut tu tc uc 0-1 2-6 7-13 14-26 27-52 53+ Weeks after accident
Traumatic versus Chronic (cont.) Three distinct patterns Medical costs Traumatic Chronic Unknown 0-1 2-6 7-13 14-26 27-52 53+ Weeks after accident
The Modelling Clusters based on medical payments at 4 points in time differentiating between level and pattern Treenet to model clusters removing direct reliance on medical payments
Clusters The Modelling (cont.)
Treenet The Modelling (cont.)
Clusters The different clusters clearly have different levels of costs 31 and different patterns 32 Costs per period 21 22 23 24 25 Costs per period 34 35 36 37 0-1 2-6 7-13 14-26 Weeks after accident 33 0-1 2-6 7-13 14-26 Weeks after accident Costs per period 11 12 13 14 0-1 2-6 7-13 14-26 Weeks after accident
Clusters (cont.) The clusters provide interesting insights into the drivers of claim severity Nomenclature: Cluster AB: A=1 = low initial payments building up A=2 = initial even level of payments building up A=3 = immediate payments running-off B=1-7 where 1 is the lowest cost level and 7 is the highest cost level
Clusters (cont.) The clusters show good separation of individual claims group 1
Clusters (cont.) The clusters show good separation of individual claims group 2
Clusters (cont.) The clusters show good separation of individual claims group 3
Model Results Chronic claims dominate group 1 while traumatic claims dominate group 3 100% 80% 60% 40% 20% 0% 11 12 13 14 21 22 23 24 25 31 32 33 34 35 36 37 Cluster Traumatic Unknown Chronic 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 11 12 13 14 21 22 23 24 25 31 32 33 34 35 36 37 Cluster Chronic Unknown Traumatic All
Model Results (cont.) The proportion of claims requiring an ambulance increases with severity N Y
Model Results (cont.) Specialist visits increase with severity Group 1 claims have limited specialist visits
Model Results (cont.) Group 2 claims have a higher average number of specialist visits
Model Results (cont.) Group 3 have the highest average specialist visits
Model Results (cont.) There is a strong relationship between severity and delay to first inpatient treatment
Model Results (cont.) There is a strong relationship between severity and delay to first inpatient treatment
Model Results (cont.) Severe traumatic clams are caused by machinery and vehicles. Few chronic claims have these agencies Machinery Powered eq Vehicle Ladders Machinery Powered eq Vehicle Ladders
Model Results (cont.) Chronic claims are more likely to be caused by unpowered equipment Unpowered eq Steps Materials Environ Unpowered eq Steps Materials Environ
Model Results (cont.) Traumatic = falls and hit by object Chronic = body stress Body stress Hitting object Falls Hit by object Body stress Hitting object Falls Hit by object Body stress Hitting object Falls Hit by object
Model Results (cont.) The key injury types differ by type of claim Chronic = musculoskeletal & back Musc/skel Back Digestive Tendonitis
Model Results (cont.) The key injury types differ by type of claim Unknown = broader spread Musc/skel Back Digestive Tendonitis
Model Results (cont.) The key injury types differ by type of claim Traumatic = fractures, joint/ligament, open wounds Amputation Joint/ligament Crushing Traum. strain Fractures Stress Open wounds Other
Model Results (cont.) Body locations differ by injury type Chronic = Back, shoulder, knee Back Knee Shoulder Psych
Model Results (cont.) Body locations differ by injury type Traumatic = Knee, hands, leg Back Knee Shoulder Psych Abdominal Leg Hands Other
Model Results (cont.) Younger workers have a higher proportion of less severe injuries 30% <25 25-35 35-45 45-55 55-65 25% 20% 15% 10% 5% 0% 11 12,13,22,21,14 31,32,33,34 23,24,25 35,36,37
Business Insights The unknown group are more challenging Medical costs Traumatic Chronic Unknown 0-1 2-6 7-13 14-26 27-52 53+ Weeks after accident
Business Insights (cont.) Disconnect between certified work capacity and pattern of treatment? Missing Alternative Modified Return to work Totally unfit
Business Insights (cont.) Same groups / clusters have poor resolution rates % reached 13 weeks compensation Traumatic Chronic Unknown 100% 80% 60% 40% 20% 0% 11 12 13 14 21 22 23 24 25 31 32 33 34 35 36 37 Cluster
Business Insights (cont.) Same groups / clusters have poor resolution rates 120% 100% 80% 60% 40% 20% 0% 26 weeks / 13 weeks compensation What % are still on benefits at 26 weeks? Traumatic Chronic Unknown 11 12 13 14 21 22 23 24 25 31 32 33 34 35 36 37 Cluster
Business Insights (cont.) Manufacturing (Food) - Injuries in 2006/07 Total Claims Time Loss Claims Number of Claims 30 25 20 15 10 5 Good (?) Bad (?) 0 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 How did we perform last month? - using injury rates to track performance
Business Insights (cont.) Manufacturing (Food) - Injuries in 2006/07 Cost $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $0 Average Estimate Average Payments Average Days Compensated Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 140 120 100 80 60 40 20 0 # Days
Business Insights (cont.) Manufacturing (Food) - Injuries in 2006/07 Cost $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $0 100% Average Estimate Average Payments Average Days Compensated Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 140 120 100 80 60 40 20 0 # Days Percentage 80% 60% 40% 20% 0% Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Chronic Unknown Acute
Business Insights (cont.) Manufacturing (Food) - Injuries in 2006/07 Cost $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $0 Severity Index 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Average Estimate Average Payments Average Days Compensated Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 140 120 100 80 60 40 20 0 # Days Severity Index
Business Insights (cont.) Manufacturing (Food) - Injuries in 2006/07 Cost $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $0 Severity Index 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Average Estimate Average Payments Average Days Compensated Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 140 120 100 80 60 40 20 0 25 20 15 10 5 0 # Days Severity Index Total Claims Time Loss Claims 30 Number of Claims