Due to the amount of data provided in this webinar, this first article will
cover COVID-19 claims data, and part two will provide more details on the
long-term medical effects associated with these claims.
Our guests were the following.
- Teresa Bartlett, MD—senior medical officer at Sedgwick
- Max Koonce—chief claims officer at Sedgwick
- Tim Stanger—vice president of partner relations at Safety National
- Alex Swedlow—president of California Workers' Compensation Institute
(CWCI)
One of the most significant challenges in analyzing workers compensation
data is that a single data source that collects and analyzes all the data does
not exist. Data is currently provided through multiple sources, such as the
National Council on Compensation Insurance, independent bureaus, monopolistic
jurisdictions, and self-insured employers. The CWCI and the Workers'
Compensation Research Institute also provide analyses around workers
compensation data.
To fill in some of the major gaps in data, panelists from the CWCI,
Sedgwick, and Safety National broke down their individual data sources to
provide a clearer picture of COVID-19's impact on workers compensation.
CWCI Claims' Data Trends
In tracking the various components of COVID-19, CWCI has developed studies
and on-demand webinars that cover the history of presumption laws, early
adjudication decisions, and how the industry leveraged telemedicine as a
response to shelter-in-place initiatives. In addition, webinars are now
available regarding legislation. When developing early COVID-19 models,
essential elements were considered, including the following.
- Infection rate
- Symptom/asymptomatic rates
- Hospital admissions
- Intensive care admissions
- Mortality rate
- Cost per claim
Early projections related to COVID-19 claims were skewed based on a lack of
stability in data modelling. The earliest data contained areas like China,
Iceland, and Greenland with infection rates that were much different than other
parts of the world. Once data became available regarding COVID-19 in the United
States, it was clear that the United States held a disproportionately large
percentage of worldwide infection rates and deaths.
California alone currently accounts for 12.6 percent of US infections and
9.6 percent of US deaths. When studying workers age 18–65 in California, they
account for 78 percent of the state's infections and 26 percent of the
deaths. However, when looking at the number of workers compensation claims in
the state, only 4.7 percent of infections and 5.6 percent of deaths have an
accompanying claim.
As of January 2021, there have been about 123,674 COVID-19 workers
compensation claims reported. Projections show about 143,432 claims expected
through the end of January 2021. Reported claims from March 2020 to January
2021 show a 12 percent drop in all non-COVID-19-related claims. However,
projections show by the end of January, the overall decrease in claims
frequency will be around 4 percent, with almost 20 percent of all claims being
COVID-19-related.
The occupational characteristics of COVID-19 claims have changed with the
fall wave of the virus. From October 2020 to January 2021, the healthcare
industry share of claims dropped around 10 percent, accounting for around 29
percent of all COVID-19 claims. First responders have seen minimal change over
the year in terms of their percentage of the total claims. Claims for the
transportation sector doubled in the fall, now accounting for 8 percent of
COVID-19 claims. Skilled nursing facilities still share a significantly higher
percentage of COVID-19 claims in health care.
Safety National Claims' Data Trends
As a leading provider of excess workers compensation for self-insured
entities, around 50 percent of Safety National's accounts consist of three
industries: public entities, healthcare networks, and education. Self-insured
data is missing from bureau analysis, making Safety National's data
unique.
Consistent with CWCI's data, overall workers compensation claims for
Safety National clients dropped around 26 percent in 2020 compared to 2019,
excluding COVID-19 claims. When including COVID-19 claims, the drop is around
10 percent. There were roughly three peaks throughout the waves of COVID-19,
including early April, early July, and early December, with the December peak
being the highest number of claims seen all year.
By age, the 20–55 bracket accounted for 84 percent of Safety National
claims, with the average claim cost being $4,300. When looking at workers over
age 55, the average claim cost was more than 3 times higher at just under
$15,000.
For death claims, 63 percent were age 56 or older, 43 percent were between
the ages of 56 to 66. For deaths, 61 percent were male, 51 percent of death
claims were in health care, and 22 percent were from municipalities (mostly
first responders).
Among the COVID-19 claims with an incurred cost of over $100,000, 15 percent
have incurred greater than $1 million. Some claims have over $2 million
incurred, including organ transplants, long intensive care stays, and even
paraplegia caused by renal failure.
Sedgwick Claims' Data Trends
Sedgwick also carries many self-insured accounts, with 24 percent of their
business being in the retail sector. Like the rest of the industry,
Sedgwick's claims also saw a high volume during the three peaks of
infection rates. Although health care only represents 11 percent of all of
their accounts, most COVID-19 claims were reported from that sector, accounting
for just over 50 percent of all reported COVID-19 claims. The retail industry
and the public sector round out the top three industries reporting COVID-19
claims. The top five states reporting COVID-19 claims are California, Texas,
Michigan, Florida, and Illinois.
When it comes to the severity of the claims, Sedgwick created a model to
project where claims would fall, grouping claims into buckets, including the
following.
- Cases that only required quarantine
- Cases that required nominal medical treatment
- Complex moderate cases
- Complex severe cases requiring admittance in an intensive care unit
(ICU)
- Fatalities
These severity groupings have closely trended with original predictions,
with fatalities, for example, accounting for just over 0.5 percent of all
claims. Approximately 1.5 percent are severe cases involving ICU stays, 8
percent are moderate cases involving several medical treatment visits, and 90
percent are mild cases involving very little medical treatment. When reviewing
these claims' value, 73 percent are valued under $5,000, and 85 percent are
valued under $10,000.
There has been a fairly even distribution of claims among the age groups due
to various industries' claims. However, the more severe claims that include
ICU stays are trending in the over-60 age group. The healthcare industry is
accounting for a higher rate of hospitalizations than the other industries,
trending 3-4 percent higher than the rest.
Overall, Sedgwick saw a decrease in overall workers compensation and
liability claims across the country due to economic shutdowns and various
employers not operating at full capacity. Even retail clients deemed essential
saw a decrease in overall claims, which could be due to a lower customer count
within the stores and an overall increase in safety measures. There has been a
slight increase in work from home claims due to ergonomic-related issues.
To listen to the archive of our complete "COVID Claims Development:
Workers' Compensation and Beyond" webinar and view a full list of
FAQs from this session, please visit
https://www.outfrontideas.com/.
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