March 15, 2018

WorkCompRecap: Examining Effectiveness!

Today’s issue of WorkCompRecap features Effective Health Systems’ recent report that examined the effectiveness of experienced workers’ comp claims adjusters at determining whether a medical treatment request should be approved or escalated to a higher-level review. According to EHS, the study found the effectiveness of adjusters in making a correct decision was less than would be expected from flipping a coin.

The study involved a retrospective review of 6,250 medical requests, and compared adjuster results to EHS’s BaseLine software. EHS noted that adjusters authorized 73% of the medical requests and sent 27% to higher-level review, while its software found that only 43% should have been authorized, and 57% should have been escalated to higher-level review.

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