title: Determinants of escalating costs in low risk workers' compensation claims.
abstract: OBJECTIVE
  To identify and quantify attributes that lead to unanticipated cost escalation in workers' compensation claims.
  
  
  METHODS
  We constructed four claim categories: low initial reserve/low cost, migrated catastrophic (low initial reserve/high cost), high initial reserve/low cost, and catastrophic (high initial reserve/high cost). To assess the attributes associated with the increased cost of migrated catastrophic claims, we analyzed 36,329 Louisiana workers' compensation claims in the four categories over a 5-year period.
  
  
  RESULTS
  In the 729 claims initially thought to be low-cost claims (migrated catastrophic), the most significant predictors for cost escalation were attorney involvement and claim duration, followed by low back disorder, married/single/divorced status, male gender, small company size, high premium, reporting delays, and older age. These injuries accounted for 2% of all claims but 32.3% of the costs. Accelerated escalation of costs occurred late in the claim cycle (2 years).
  
  
  CONCLUSIONS
  Certain attributes, particularly attorney involvement and claim duration, are associated with unanticipated cost escalation in a small number of claims that drastically affect overall losses. The results of this study suggest that these cases may be identified and addressed before rapid escalation occurs.
authors.affiliation: Division of Occupational and Environmental Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21287-1629, USA. bernacki@jhmi.edu
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Bernacki
authors.forename: Larry
authors.initials: L
authors.lastname: Yuspeh
authors.forename: Xuguang
authors.initials: X
authors.lastname: Tao
mesh_terms: D000062:Accidents, Occupational; D000328:Adult; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008145:Louisiana; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D014942:Workers' Compensation / Q000191:economics*