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Medical Cost Trends in the Texas
Workers’ Compensation System
Texas Department of Insurance
Workers’ Compensation Research Group
August 2004
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Purpose of This Analysis
• To update the average medical cost per claim
for all injuries through injury year 2003,
one-year post injury; and
• To analyze the average medical cost per claim
for specific types of injuries through injury
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Data and Methods
• Data comes from Texas Workers’ Compensation Commission
(TWCC) medical database, as of April 2004.
• To ensure an “apples to apples” comparison, TDI grouped all
diagnoses into diagnostic “buckets” according to a
methodology prescribed by the American College of
Occupational and Environmental Medicine (ACOEM).
• Average medical costs per claim for “all injuries” were
calculated for injury years 1999-2003 at one-year post injury
to ensure that all claims included in the analysis have the same
claim maturity.
• Average medical costs for specific types of injuries were only
calculated for injury years 1999-2002 at one-year post injury
since diagnostic groupings may change once insurance carriers
have submitted all remaining medical data pertaining to 2003
and 2004 medical services to TWCC.
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Key Medical Cost Findings
for “All Injuries”
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Average Workers’ Compensation Medical Cost Per
Claim, All Injuries, Injury Years 1999-2003,
One-Year Post Injury
$2,288 $2,409 $2,758 $2,951 $3,078* $0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 Injury Year 1999 Injury Year 2000 Injury Year 2001 Injury Year 2002 Injury Year 2003
Source: Texas Workers’ Compensation Commission, Medforms database, as of April 2004 and the Texas Department of Insurance, Workers’ Compensation Research Group, August 2004.
Note: Average medical costs per claim do not include pharmacy costs. * Average medical cost estimates for injury year 2003 should be considered preliminary until insurance carriers have submitted all remaining medical data pertaining to 2003 and 2004 medical services to the Texas Workers’ Compensation Commission.
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Average Workers’ Compensation Medical Cost Per Claim,
All Injuries, Injury Years 1999-2003,
One-Year Post Injury
+4.3%*
$3,078*
2003*
+34.5%
Total medical cost increase
from injury years 1999 to 2003
+7.0%
$2,951
2002
+14.5%
$2,758
2001
+5.3%
$2,409
2000
$2,288
1999
Average Annual Increase in
Medical Costs
Average Medical Cost
Per Claim
Injury Year
Source: Texas Workers’ Compensation Commission, Medforms database, as of April 2004 and the Texas Department of Insurance, Workers’ Compensation Research Group, August 2004.
Note: Average medical costs per claim do not include pharmacy costs. * Average medical cost estimates for injury year 2003 should be considered preliminary until insurance carriers have submitted all remaining medical data pertaining to 2003 and 2004 medical services to the Texas Workers’ Compensation Commission.
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Key Medical Cost Findings for
Specific Types of Injuries
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Average Workers’ Compensation Medical Cost Per
Claim, Ankle and Foot Soft Tissue Injuries,
Injury Years 1999-2002, One-Year Post Injury
$1,313 $1,361 $1,619 $1,677 $0 $400 $800 $1,200 $1,600 $2,000
Injury Year 1999 Injury Year 2000 Injury Year 2001 Injury Year 2002
Source: Texas Workers’ Compensation Commission (TWCC), Medforms database, as of April 2004 and the Texas Department of Insurance, Workers’ Compensation Research Group, August 2004.
Note: Average medical costs per claim do not include pharmacy costs. Average medical cost estimates for injury year 2003 are not included because diagnostic groupings may change once insurance carriers have submitted all remaining medical data pertaining to 2003 and 2004 medical services to TWCC.
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Average Workers’ Compensation Medical Cost Per
Claim, Hand and Wrist Nerve Compression Injuries,
Injury Years 1999-2002, One-Year Post Injury
$4,618 $4,716 $5,632 $5,922 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000
Injury Year 1999 Injury Year 2000 Injury Year 2001 Injury Year 2002
Source: Texas Workers’ Compensation Commission (TWCC), Medforms database, as of April 2004 and the Texas Department of Insurance, Workers’ Compensation Research Group, August 2004.
Note: Average medical costs per claim do not include pharmacy costs. Average medical cost estimates for injury year 2003 are not included because diagnostic groupings may change once insurance carriers have submitted all remaining medical data pertaining to 2003 and 2004 medical services to TWCC.
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Average Workers’ Compensation Medical Cost Per
Claim, Hand and Wrist Soft Tissue Injuries,
Injury Years 1999-2002, One-Year Post Injury
$1,710 $1,801 $2,336 $2,358 $0 $500 $1,000 $1,500 $2,000 $2,500
Injury Year 1999 Injury Year 2000 Injury Year 2001 Injury Year 2002
Source: Texas Workers’ Compensation Commission (TWCC), Medforms database, as of April 2004 and the Texas Department of Insurance, Workers’ Compensation Research Group, August 2004.
Note: Average medical costs per claim do not include pharmacy costs. Average medical cost estimates for injury year 2003 are not included because diagnostic groupings may change once insurance carriers have submitted all remaining medical data pertaining to 2003 and 2004 medical services to TWCC.
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Average Workers’ Compensation Medical Cost Per
Claim, Hand and Wrist Superficial Trauma,
Injury Years 1999-2002, One-Year Post Injury
$673 $669 $783 $893 $0 $200 $400 $600 $800 $1,000
Injury Year 1999 Injury Year 2000 Injury Year 2001 Injury Year 2002
Source: Texas Workers’ Compensation Commission (TWCC), Medforms database, as of April 2004 and the Texas Department of Insurance, Workers’ Compensation Research Group, August 2004.
Note: Average medical costs per claim do not include pharmacy costs. Average medical cost estimates for injury year 2003 are not included because diagnostic groupings may change once insurance carriers have submitted all remaining medical data pertaining to 2003 and 2004 medical services to TWCC.
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Average Workers’ Compensation Medical Cost Per
Claim, Knee Internal Derangement Injuries,
Injury Years 1999-2002, One-Year Post Injury
$4,573 $4,484 $5,112 $5,621 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000
Injury Year 1999 Injury Year 2000 Injury Year 2001 Injury Year 2002
Source: Texas Workers’ Compensation Commission (TWCC), Medforms database, as of April 2004 and the Texas Department of Insurance, Workers’ Compensation Research Group, August 2004.
Note: Average medical costs per claim do not include pharmacy costs. Average medical cost estimates for injury year 2003 are not included because diagnostic groupings may change once insurance carriers have submitted all remaining medical data pertaining to 2003 and 2004 medical services to TWCC.
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Average Workers’ Compensation Medical Cost Per
Claim, Low Back Nerve Compression Injuries,
Injury Years 1999-2002, One-Year Post Injury
$9,260 $9,783 $10,760 $12,477 $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000
Injury Year 1999 Injury Year 2000 Injury Year 2001 Injury Year 2002
Source: Texas Workers’ Compensation Commission (TWCC), Medforms database, as of April 2004 and the Texas Department of Insurance, Workers’ Compensation Research Group, August 2004.
Note: Average medical costs per claim do not include pharmacy costs. Average medical cost estimates for injury year 2003 are not included because diagnostic groupings may change once insurance carriers have submitted all remaining medical data pertaining to 2003 and 2004 medical services to TWCC.
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Average Workers’ Compensation Medical Cost Per
Claim, Low Back Soft Tissue Injuries,
Injury Years 1999-2002, One-Year Post Injury
$3,223 $3,507 $3,976 $4,236 $0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000 $4,500
Injury Year 1999 Injury Year 2000 Injury Year 2001 Injury Year 2002
Source: Texas Workers’ Compensation Commission (TWCC), Medforms database, as of April 2004 and the Texas Department of Insurance, Workers’ Compensation Research Group, August 2004.
Note: Average medical costs per claim do not include pharmacy costs. Average medical cost estimates for injury year 2003 are not included because diagnostic groupings may change once insurance carriers have submitted all remaining medical data pertaining to 2003 and 2004 medical services to TWCC.
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Average Workers’ Compensation Medical Cost Per
Claim, Multiple Body Parts Soft Tissue Injuries,
Injury Years 1999-2002, One-Year Post Injury
$2,153 $2,317 $2,644 $2,905 $0 $500 $1,000 $1,500 $2,000 $2,500 $3,000
Injury Year 1999 Injury Year 2000 Injury Year 2001 Injury Year 2002
Source: Texas Workers’ Compensation Commission (TWCC), Medforms database, as of April 2004 and the Texas Department of Insurance, Workers’ Compensation Research Group, August 2004.
Note: Average medical costs per claim do not include pharmacy costs. Average medical cost estimates for injury year 2003 are not included because diagnostic groupings may change once insurance carriers have submitted all remaining medical data pertaining to 2003 and 2004 medical services to TWCC.
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Average Workers’ Compensation Medical Cost Per
Claim, Neck Soft Tissue Injuries,
Injury Years 1999-2002, One-Year Post Injury
$4,378 $4,575 $5,053 $5,332 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000
Injury Year 1999 Injury Year 2000 Injury Year 2001 Injury Year 2002
Source: Texas Workers’ Compensation Commission (TWCC), Medforms database, as of April 2004 and the Texas Department of Insurance, Workers’ Compensation Research Group, August 2004.
Note: Average medical costs per claim do not include pharmacy costs. Average medical cost estimates for injury year 2003 are not included because diagnostic groupings may change once insurance carriers have submitted all remaining medical data pertaining to 2003 and 2004 medical services to TWCC.
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Average Workers’ Compensation Medical Cost Per
Claim, Shoulder Soft Tissue Injuries,
Injury Years 1999-2002, One-Year Post Injury
$3,788 $4,113 $4,775 $5,221 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000
Injury Year 1999 Injury Year 2000 Injury Year 2001 Injury Year 2002
Source: Texas Workers’ Compensation Commission (TWCC), Medforms database, as of April 2004 and the Texas Department of Insurance, Workers’ Compensation Research Group, August 2004.
Note: Average medical costs per claim do not include pharmacy costs. Average medical cost estimates for injury year 2003 are not included because diagnostic groupings may change once insurance carriers have submitted all remaining medical data pertaining to 2003 and 2004 medical services to TWCC.
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Average Workers’ Compensation Medical Cost Per
Claim, All Other Injuries, Injury Years 1999-2002,
One-Year Post Injury
$2,860 $2,899 $3,353 $3,574 $0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000
Injury Year 1999 Injury Year 2000 Injury Year 2001 Injury Year 2002
Source: Texas Workers’ Compensation Commission (TWCC), Medforms database, as of April 2004 and the Texas Department of Insurance, Workers’ Compensation Research Group, August 2004.
Note: Average medical costs per claim do not include pharmacy costs. Average medical cost estimates for injury year 2003 are not included because diagnostic groupings may change once insurance carriers have submitted all remaining medical data pertaining to 2003 and 2004 medical services to TWCC.
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