Trends and Breakpoints in Workers Comp Loss Costs:

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1 ANTITRUST Notice The Casualty Actuarial Society is committed to adhering strictly tl to the letter and spirit of the antitrust laws. Seminars conducted under the auspices of the CAS are designed solely to provide a forum for the expression of various points of view on topics described in the programs or agendas for such meetings. Under no circumstances shall CAS seminars be used as a means for competing companies or firms to reach any understanding expressed or implied that restricts competition or in any way impairs the ability of members to exercise independent business judgment regarding matters affecting competition. It is the responsibility of all seminar participants to be aware of antitrust regulations, to prevent any written or verbal discussions that appear to violate these laws, and to adhere in every respect to the CAS antitrust compliance policy.

2 Trends and Breakpoints in Workers Comp Loss Costs: What Makes Medical and Indemnity Different? Presented by Harry Shuford CAS Ratemaking and Product Management Seminar Trends in Workers Compensation Medical Costs March 21, 2011 New Orleans, Louisiana

3 Trends and Breakpoints in WC Loss Costs What s Different About Medical and Indemnity Loss Cost Trends? Looking at the Pieces: Loss Costs Frequency Severity Price Utilization 3

4 Tracking Trends in Loss Costs Loss Costs per Worker Medical & Indemnity 4

5 WC Loss Cost Trends Medical & Indemnity Seem to Diverge around 2001 Cost per Worker Medical & Indemnity LossCosts per Worker $300 $250 $200 $150 $100 Medical Loss Cost $50 Indemnity Loss Cost $

6 Tracking Trends in Loss Costs Rates of Change in Loss Costs per Worker Medical & Indemnity 6

7 Medical & Indemnity Loss Cost Trends Rates of Change Seem to Follow a Similar Pattern Cost per Worker Medical & Indemnity Loss Costs per Worker 14% annual rates of change (ln) 12% 10% 8% 6% 4% 2% 0% -2% % -6% -8% Medical Loss Cost per Worker Indemnity Loss Cost per Worker 7

8 Medical and Indemnity Loss Costs - The Pattern: : Strong Growth : Easing Growth : Limited Growth 8

9 Tracking Trends in Loss Costs Frequency Trends 9

10 Tracking the Decline in Frequency of Workplace Injuries Can We Identify the Drivers? Harry Shuford, PhD Practice Leader and Chief Economist CAS Ratemaking Seminar - WC-4: Key Drivers of Workers Compensation Costs - Economic Perspectives March 8, 2007 Atlanta, GA Copyright 2007 National Council on Compensation Insurance, Inc. All Rights Reserved.

12 Predicting Changes in Frequency of Workplace Injuries Manufacturing i Factor Trend Unemployment rate (change) Result Declining Unemployment up, frequency down Younger Workers (share of labor force) More younger workers, frequency up Reporting anomaly (1986/1987) Frequency increase overstated Significant? 99% 99% 95% 99% Copyright 2007 National Council on Compensation Insurance, Inc. All Rights Reserved. 12

13 Modeling the Change in the Log of the Incidence Rate of Injuries in Mfg. Trend LDUNR LDGDP LDEMPSH DUM R2 Model t value (-3.03) (-5.99) (2.66) (4.01) Model t value (-4.93) (6.19) (1.92) (4.28) Copyright 2007 National Council on Compensation Insurance, Inc. All Rights Reserved. 13

14 15.0% Forecast of Percent Change in Manufacturing Incidence Rates 10.0% Actual Fitted/Forecast 5.0% 0.0% -5.0% -10.0% 0% -15.0% '75 '77 '79 '81 '83 '85 '87 '89 '91 '93 '95 '97 '99 '01 '03 '05 '07 '09 Source: U.S Bureau of Labor Statistics, NCCI Copyright 2007 National Council on Compensation Insurance, Inc. All Rights Reserved. 14

15 Frequency Is No Longer a Mystery Long Term Economic forces drive frequency downward This is likely to continue Short Term Cyclical fluctuations in the number of inexperienced workers puts some upward pressure on frequency This is likely to continue short-term outlook is uncertain Young Workers Have Higher Frequency This is becoming less significant Copyright 2007 National Council on Compensation Insurance, Inc. All Rights Reserved. 15

16 Tracking Trends in Loss Costs Looking for the Turning Point Breakpoints in Frequency Trends 16

17 Characteristics of Frequency: Turning Points Along a Long-Term Drift Downward Manufacturing Total Recordable Cases Rate of Injury and Illness Cases per 100 full-time workers Noting Turning Points Injury and Illness Rates - Mfg '26 '28 '30 '32 '34 '36 '38 '40 '42 '44 '46 '48 '50 '52 '54 '56 '58 '60 '62 '64 '66 '68 '70 '72 '74 '76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '06 '08 Note: Recessions indicated by gray bars Source: U.S. Bureau of Labor Statistics; National Bureau of Economic Research

18 Characteristics of Frequency: Turning Points Along a Long-Term Drift Downward Manufacturing Total Recordable Cases Rate of Injury and Illness Cases per 100 full-time workers 10 Share of Workforce Aged 15 to 24 Departure from Trend 8 6 Incidence Rates _ dev trend Labor Force Share 15 to 24 cohort - dev trend Note: Recessions indicated by gray bars Source: U.S. Bureau of Labor Statistics; National Bureau of Economic Research

19 Workplace Injury Incidence Rates for Manufacturing Something Different in the 1980s 15 3,750 ers 0 FTE Work 10 2,500 Claims pe Incidence Rates per 10 (BLS) 5 0 Recessions Manufacturing Industry Injuries and Illnesses per 100 Full-Time Workers Private Industry Injuries and Illnesses per 100 Full-Time Workers NCCI Lost-Time Claims per 100,000 Workers 1,250 0 r 100,000 W orkers (NCCI) 2009p Source: US Department of Labor, Bureau of Labor Statistics (BLS), National Bureau of Economic Research NCCI Frequency and Severity Analysis 19

20 Workplace Injury Incidence Rates for Private Industry No So Different in the 1980s chng (ln) NCCI Lost-Time Claims per 100, Workers chng (ln) Private Industry Injuries and Illnesses per 100 Full-Time Workers dev % chng real GDP 15% 10% 5% 0% -5% -10% Claims per 100,000 Workers (NCCI) -15% 2009p Source: US Department of Labor, Bureau of Labor Statistics (BLS), National Bureau of Economic Research NCCI Frequency and Severity Analysis 20

21 Tracking Trends in Loss Costs Changes in Frequency No Turning Point 21

22 WC Loss Cost Trends Frequency per # Workers Typically Declined Rate of Change in Frequency 14% NCCI Lost-Time Claims per 100, Workers 12% 10% 8% 6% NCCI Lost-Time Claims per 100,000 Workers 4% 2% 0% -2% % -6% -8% 22

23 Frequency Changes - The Pattern: : Marked Declines : Increase & Smaller Declines : Marked Declines : Smaller Declines 23

24 Tracking Trends in Loss Costs Removing the Contribution of Frequency Medical and Indemnity Severity Trends 24

25 A Breakpoint in Workers Comp Severitieserities Impact of Reform in the Early 1990s

26 The Growth in Medical Severity Eased Following Reforms in Early 1990s Medical Cost per Claim ($000) $45 Economic Recessions $40 $35 $30 $25 $20 $15 $10 If 1994 thru 2008 grew at the same average annual rate as 1984 through 1990 Bending the Curve? $5 $0 Impact ( shock ) of reforms '80 '81 '82 '83 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07'08p Accident/Calendar Year 2008p: Preliminary based on data valued as of 12/31/ : Based on data through 12/31/2007, developed to ultimate Based on the states where NCCI provides ratemaking services, including state funds Excludes high deductible policies Copyright 2011 National Council on Compensation Insurance, Inc. All Rights Reserved.

27 The Growth in Indemnity Severity Temporarily Flat Following Reforms in Early 1990s Marked Decline Starting Around 2002 $45 Economic Recessions $40 $35 Indemnity Cost per Claim ($000) $30 If 1994 thru 2008 grew at Bending the Curve? the same average annual $25 rate as 1984 through 1990 $20 $15 $10 $5 Impact ( shock ) of reforms $0 '80 '81 '82 '83 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07'08p Accident/Calendar Year 2008p: Preliminary based on data valued as of 12/31/ : Based on data through 12/31/2007, developed to ultimate Based on the states where NCCI provides ratemaking services, including state funds Excludes high deductible policies Copyright 2011 National Council on Compensation Insurance, Inc. All Rights Reserved.

28 Workers Comp Severities Two Decades of Post Reform Growth Surprisingly Similar Even Post 2001

29 WC Medical Claim Costs Will Moderate Trends Continue? Medical Claim Cost (000s) 35 Annual Change : +1.9% Average Medical Cost per Lost-Time Claim Annual Change : +8.9% +5.0% +6.7% Annual Change : +6.6% +5.4% +7.4% +5.4% +8.8% +7.3%+5.6% +13.5% +7.3% +8.3% +10.6% +6.8%+1.3% -2.1% +9.0%+5.1%+7.4%+10.1% $8.4 $8.5 $8.4 $ 9.1 $9 9.6 $1 0.3 $ $ $13. 6 $ p Accident/Calendar Year 2009p: Preliminary based on data valued as of 12/31/ : Based on data through 12/31/2008, developed to ultimate Based on the states where NCCI provides ratemaking services, including state funds Excludes high deductible policies $16.5 $18.0 $19.3 $20.4 $21.9 $23.0 $24.3 $25.9 $27.2

30 Workers Compensation Indemnity Claim Costs Growth Has Eased Indemnity Claim Cost (000s) 35 Annual Change : -1.7% Annual Change : +7.3% Annual Change : +3.4% Average Indemnity Cost per Lost-Time Claim +9.0% +10.1%+10.1% +7.7% +1.0% -3.1% -2.8% +4.9% +1.7% +5.9% $ $9 9.7 $9 9.4 $9 9.9 $ $ $11.5 $12..5 $13.8 $ % +3.4% +5.0% +9.2% +3.1% +4.4% +1.3% +3.0% p Accident/Calendar Year 2008p: Preliminary based on data valued as of 12/31/ : Based on data through 12/31/2007, developed to ultimate Based on the states where NCCI provides ratemaking services, including state funds Excludes high deductible policies 30 $16.6 $17.1 $17.9 $18.1 $18.6 $19.5 $20.2 $21.2

31 WC Indemnity Severity Growth Changes Closely Followed Medical Severity Medical Severity Indemnity Severity Annual Change : 1.9% -1.7% Annual Change : 8.9% 7.3% Annual Change : 6.6% 3.4% 31

32 WC Loss Cost Trends Rates of Change in Medical and Indemnity Severity Also Followed a Similar Pattern 14% Medical & Indemnity Severities annual rates of change (ln) 12% Med Severity Chng (ln) Indemnity Severity Chng (ln) 10% 8% 6% 4% 2% 0% -2% % -6% -8% 32

33 Severities - The Pattern: : Strong Growth : Easing Growth : Moderate Growth 33

34 Workers Compensation Severity Drivers 34

35 A Model of Claims Costs Cost = Price x Utilization 35

36 A Model of Claims Costs Cost = Price x Utilization Medical => Medical Consumer Price Index (MCPI) Indemnity => Average Weekly Wage (AWW) 36

37 Different Patterns of Change in Two Measures of Price Inflation: Medical CPI and Average Weekly Wage 37

38 Percent Change Medical CPI Inflation Relatively Stable since mid 1990s Change in Medical CPI p Year Indemnity severity 2008p: Preliminary based on data valued as of 12/31/2008 Indemnity severity : Based on data through 12/31/2007, developed to ultimate Based on the states where NCCI provides ratemaking services, including state funds; excludes high deductible policies Source: CPS Wage All states (Current Population Survey), Economy.com; Accident year indemnity severity NCCI states, NCCI 38

39 Wage Inflation Tracks the Business Cycle Strong in Expansions, Eases in Recessions Percent Change Change in CPS Wage p Year Indemnity severity 2008p: Preliminary based on data valued as of 12/31/2008 Indemnity severity : Based on data through 12/31/2007, developed to ultimate Based on the states where NCCI provides ratemaking services, including state funds; excludes high deductible policies Source: CPS Wage All states (Current Population Survey), Economy.com; Accident year indemnity severity NCCI states, NCCI 39

40 Changing Prices Likely Are Only A Modest Factor in Severity Growth Tracking Medical and Wage Price Trends % 12% 10% 8% MCPI inflation (ln) AWW inflation (ln) 6% 4% 2% 0% -2% p -4% -6% 40

41 Price Inflation and Severity Changes Medical and Indemnity 41

42 A Model of Claims Costs Cost = Price x Utilization 42

43 A Model of Claims Costs Utilization The Key Cost Driver in the Late 1990s Less of a Factor since

WC Medical Severity Significantly Outpaced MCPI Inflation in the Late 1990s => Utilization Percent Change 15 12 10.1 Average Medical Cost per Lost-Time Claims 10.6 13.

44 WC Medical Severity Significantly Outpaced MCPI Inflation in the Late 1990s => Utilization Percent Change Average Medical Cost per Lost-Time Claims Change in Medical Claim Cost Change in Medical CPI p Year Indemnity severity 2008p: Preliminary based on data valued as of 12/31/2008 Indemnity severity : Based on data through 12/31/2007, developed to ultimate Based on the states where NCCI provides ratemaking services, including state funds; excludes high deductible policies Source: CPS Wage All states (Current Population Survey), Economy.com; Accident year indemnity severity NCCI states, NCCI 44

45 Indemnity Severity Significantly Outpaced Wage Inflation in the Late 1990s => Utilization Percent Change Average Indemnity Cost per Lost-Time Claims Change in Indemnity Cost per Lost-Time Claim Change in Average Weekly Wage p Indemnity severity 2009p: Preliminary based on data valued as of 12/31/2009 Year Indemnity severity : Based on data through 12/31/2008, developed to ultimate Based on the states where NCCI provides ratemaking services, including state funds; excludes high deductible policies Source: Average Weekly Wage : Quarterly Census of Employment and Wages, Economy.com; 2009p, NCCI Accident year indemnity severity NCCI states, NCCI 45

46 Tracking Trends in Loss Costs Removing the Contribution of Price Medical and Indemnity Utilization Trends 46

47 Growth in Utilization Likely the Key Driver of Severity in the Late 1990s 14% Rate of Change in Medical and Indemnity Utilization Estimated by Subtracting ln Growth Rates of MCPI & AWW from ln Growth Rates of Medical and Indemnity Severity 12% 10% Med Util Chng (ln) Indem Util Chng (ln) 8% 6% 4% 2% 0% -2% p -4% -6% 47

48 Utilization - The Pattern: : Strong Growth : Modest to Limited Growth 48

49 Medical and Indemnity Utilization 49

50 Factors Driving Temporary Medical and Indemnity Severity

51 A Model of Claims Costs Cost = Price x Utilization 51

52 A Model of Claims Costs Cost = Price x Utilization Utilization = Quantity and Mix 52

53 Share of Medical and Indemnity Severity Increases (For Claims with Temporary Payments) Due to Mix, Quantity, and Price Paid Temporary Indemnity Severities & Paid Medical Severities on Temporary Lost-Time Claims Closed Within 24 Months of Date of Injury, NCCI States Medical 1996/ /01 Indemnity 1996/ /01 Total 55% 100% 50% 100% Share Due to Diagnosis Mix Share Due to Number of Treatments or Duration Share Due to Price and Other Factors Source: NCCI 53

54 A Model of Claims Costs Utilization The Joint Effect of Mix and Quantity 54

55 A Model of Claims Costs Utilization Change in Mix of Injuries 55

56 Changes in the Mix of Diagnoses for Claims with Temporary Payments Top 10 Claim Diagnoses by Accident Year for Lost-Time Claims with Temporary Payments That Closed Within 24 Months of Date of Injury Accident Years 1996/1997 Accident Years 2000/2001 Diagnosis and Severity Index 1 Sprain Lumbar Region Sprain Lumbar Region Diagnosis and Severity Index 2 Lower Leg Injury, not otherwise specified Lower Leg Injury, not otherwise specified 3 Unilateral Inguinal Hernia Carpal Tunnel Syndrome 4 Carpal Tunnel Syndrome Unilateral Inguinal Hernia 5 Sprain Lumbosacral Cervicalgia 6 Lumbar Disc Displacement Lumbar Disc Displacement 7 Cervicalgia Tear Medial Cartilage/Meniscus of Knee 8 Sprain of Ankle, not otherwise specified Sprain Rotator Cuff 9 Lumbago Sprain of Ankle, not otherwise specified 10 Sprain of Neck Lumbosacral Neuritis, not otherwise specified The severity index is the ratio of paid indemnity severity for that diagnosis to overall average paid indemnity severity. Source: NCCI 56

57 Share of Medical and Indemnity Severity Increases (For Claims with Temporary Payments) Due to Mix, Quantity, and Price Paid Temporary Indemnity Severities & Paid Medical Severities on Temporary Lost-Time Claims Closed Within 24 Months of Date of Injury, NCCI States Medical 1996/ /01 Indemnity 1996/ /01 Total 55% 100% 50% 100% Share Due to Diagnosis Mix 11% 20% 10% 19% Share Due to Number of Treatments or Duration Share Due to Price and Other Factors Source: NCCI 57

58 A Model of Claims Costs Utilization = Quantity and Mix Quantity Quantity => Treatments per Claim Quantity => Duration of Temporary Payments 58

59 Comparison of Two Measures of Utilization: Treatments per Claim and Duration 59

60 120 Duration and Treatments per Claim Correlation = Duration (in days) for Temporary Payments Number of Treatments per Claim Accident Year Temporary Lost-Time Claims Closed Within 24 Months of Date of Injury, NCCI States Source: NCCI 60

61 Change in Duration and Treatments per Claim Correlation = % Duration (in days) for Temporary Payments 15% Number of Treatments t per Claim 10% 5% 0% -5% % Accident Year Temporary Lost-Time Claims Closed Within 24 Months of Date of Injury, NCCI States Source: NCCI 61

62 Share of Medical and Indemnity Severity Increases (For Claims with Temporary Payments) Due to Mix, Quantity, and Price Paid Temporary Indemnity Severities & Paid Medical Severities on Temporary Lost-Time Claims Closed Within 24 Months of Date of Injury, NCCI States Medical 1996/ /01 Indemnity 1996/ /01 Total 55% 100% 50% 100% Share Due to Diagnosis Mix 11% 20% 10% 19% Share Due to Number of Treatments or Duration Share Due to Price and Other Factors 31% 57% 18% 36% 13% 23% 22% 45% % Increase in MCPI 1996/ /01 = 15% % Increase in AWW 1996/ /01 = 20% 62

63 Factors Driving Temporary Medical & Indemnity Severity

64 Share of Medical and Indemnity Severity Increases (For Claims with Temporary Payments) Due to Mix, Quantity, and Price Paid Temporary Indemnity Severities & Paid Medical Severities on Temporary Lost-Time Claims Closed Within 24 Months of Date of Injury, NCCI States Medical 2001/ /06 Indemnity 2001/ /06 Total 22% 100% 5% 100% Share Due to Diagnosis Mix Share Due to Number of Treatments or Duration Share Due to Price and Other Factors Source: NCCI 64

65 Changes in the Mix of Diagnoses for Claims with Temporary Payments Top 10 Claim Diagnoses by Accident Year for Lost-Time Claims with Temporary Payments That Closed Within 24 Months of Date of Injury Accident Years 2001/2002 Accident Years 2005/2006 Diagnosis and Severity Index Diagnosis and Severity Index 1 Sprain Lumbar Region 0.49 Lower Leg Injury, not otherwise specified Lower Leg Injury, not otherwise specified Sprain Lumbar Region Carpal Tunnel Syndrome 1.33 Unilateral Inguinal Hernia Unilateral Inguinal Hernia 0.70 Cervicalgia Cervicalgia 1.47 Sprain Rotator Cuff Lumbar Disc Displacement 2.11 Tear Medial Cartilage/Meniscus of Knee Tear Medial Cartilage/Meniscus of Knee 1.43 Carpal Tunnel Syndrome Sprain Rotator Cuff 2.03 Lumbar Disc Displacement Sprain of Ankle, not otherwise specified Lumbosacral Neuritis, not otherwise specified 1.82 The severity index is the ratio of paid indemnity severity for that diagnosis to overall average paid indemnity severity. Source: NCCI Rotator Cuff Syndrome, not otherwise specified Lumbosacral Neuritis, not otherwise specified

66 Share of Medical and Indemnity Severity Increases (For Claims with Temporary Payments) Due to Mix, Quantity, and Price Paid Temporary Indemnity Severities & Paid Medical Severities on Temporary Lost-Time Claims Closed Within 24 Months of Date of Injury, NCCI States Medical 2001/ /06 Indemnity 2001/ /06 Total 22% 100% 5% 100% Share Due to Diagnosis Mix 4% 20% 3% 52% Share Due to Number of Treatments or Duration Share Due to Price and Other Factors Source: NCCI 66

67 Change in Duration and Treatments per Claim Correlation = % Duration (in days) for Temporary Payments Number of Treatments per Claim 15% 10% 5% 0% -5% % Accident Year Temporary Lost-Time Claims Closed Within 24 Months of Date of Injury, NCCI States Source: NCCI 67

68 Share of Medical and Indemnity Severity Increases (For Claims with Temporary Payments) Due to Mix, Quantity, and Price Paid Temporary Indemnity Severities & Paid Medical Severities on Temporary Lost-Time Claims Closed Within 24 Months of Date of Injury, NCCI States Medical 2001/ /06 Indemnity 2001/ /06 Total 22% 100% 5% 100% Share Due to Diagnosis Mix 4% 20% 3% 52% Share Due to Number of Treatments or Duration Share Due to Price and Other Factors -5% -22% -9% -194% 23% 102% 12% 246% % Increase in MCPI 2001/ /06 = 18% % Increase in AWW 2001/ /06 = 11% Source: NCCI 68

69 Comparison of Two Measures of Utilization: Treatments per Claim and Duration 69

70 Utilization - The Pattern: : Modest Growth : Strong Growth : No Growth 70

71 Change in Duration and Treatments per Claim Correlation = % Duration (in days) for Temporary Payments 15% Number of Treatments per Claim 10% 5% 0% -5% % Accident Year Temporary Lost-Time Claims Closed Within 24 Months of Date of Injury, NCCI States Source: NCCI 71

72 Utilization - The Pattern: : Modest Growth : Strong Growth : No Growth Is There an Explanation? 72

73 What Changed? Duration Slower Return to Work: Recession & Recovery More surgery Number of Medical Treatments: Fee schedules More surgery Recession & Recovery 73

74 Reviewing the Pieces: Loss Costs Frequency Severity Pi Price Utilization 74

75 Medical & Indemnity Loss Cost Trends Rates of Change Seem to Follow a Similar Pattern Cost per Worker Medical & Indemnity Loss Costs per Worker 14% annual rates of change (ln) 12% 10% 8% 6% 4% 2% 0% -2% % -6% -8% Medical Loss Cost per Worker Indemnity Loss Cost per Worker 75

76 WC Loss Cost Trends Frequency per # Workers Typically Declined Rate of Change in Frequency 14% NCCI Lost-Time Claims per 100, Workers 12% 10% 8% 6% NCCI Lost-Time Claims per 100,000 Workers 4% 2% 0% -2% % -6% -8% 76

77 WC Loss Cost Trends Rates of Change in Medical and Indemnity Severity Also Followed a Similar Pattern 14% Medical & Indemnity Severities annual rates of change (ln) 12% Med Severity Chng (ln) Indemnity Severity Chng (ln) 10% 8% 6% 4% 2% 0% -2% % -6% -8% 77

78 Changing Prices Likely Are Only A Modest Factor in Severity Growth Tracking Medical and Wage Price Trends % 12% 10% 8% MCPI inflation (ln) AWW inflation (ln) 6% 4% 2% 0% -2% p -4% -6% 78

79 Growth in Utilization Likely the Key Driver of Severity in the Late 1990s 14% Rate of Change in Medical and Indemnity Utilization Estimated by Subtracting ln Growth Rates of MCPI & AWW from ln Growth Rates of Medical and Indemnity Severity 12% 10% Med Util Chng (ln) Indem Util Chng (ln) 8% 6% 4% 2% 0% -2% p -4% -6% 79

80 Questions and More Information Seven papers on this subject are available for download in the Research and Outlook Section on ncci.com Measuring the Factors Driving Medical Severity: Price, Utilization, Mix posted in Spring 2007 Factors Influencing the Growth in Treatments per Claim posted in September 2008 Significant Changes in Factors Driving Medical Severity vs , An Update posted in July 2010 Workers Compensation Temporary Total Disability Indemnity Benefit Duration 2010 Update posted in February 2011 The Relationship between Medical Utilization and Indemnity Claim Severity posted in March 2011 Workplace Injuries and Job Flows posted in July 2009 An Analysis of Factors Affecting Changes in Manufacturing Incidence Rates posted in August 2006 Plus: State of the Line presentations from NCCI s Annual Issues Symposium, 2009 &

81 Thank You Questions

Introduction NCCI RESEARCH BRIEF. July 2010

Introduction NCCI RESEARCH BRIEF. July 2010 NCCI RESEARCH BRIEF July 2010 by Tanya Restrepo and Harry Shuford Significant Changes in the Factors Driving Medical Severity 1996 2001 vs. 2001 2006 An Update to Measuring the Factors Driving Medical