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Hospitalization, fatalities more likely in COVID medical claims

While the majority of workers compensation claims for COVID-19 during the first year of the pandemic involved a mild infection and no hospitalization, the Workers’ Compensation Insurance Rating Bureau of California reports that coronavirus claims with medical payments were more likely to involve hospitalization, intensive care and fatalities.

“As a result, the average medical payments per COVID-19 claim during the first six months of medical treatment [were] almost two times higher than the average medical payments per non-COVID-19 claim,” the WCIRB said in a report published Wednesday.

“For claims of similar disease severity, however, COVID-19 claims generally incurred lower average medical payments over six months than non-COVID-19 claims, except for COVID-19 death claims, which were more likely to involve hospitalization, have higher inpatient costs and longer hospital stays than non-COVID-19 death claims.”

The WCIRB reviewed a sample of nearly 6,000 COVID-19 claims filed with insurers for dates of injury between March 2020 and March 2021 that included medical payments for its analysis.

The majority of claims, about 90%, were for mild illnesses and did not require hospitalization. The WCIRB reports that 4% of claims were for severe illnesses that required hospitalization but no time in an intensive care unit; another 4% required ICU care for critical conditions; and 2% were death claims.

Average medical payments on COVID-19 claims increase significantly as infections become more severe.

“For COVID-19 claims with severe and critical infections, the payments for hospital admissions were the main cost driver,” the report said.

WCIRB reports the average medical payment on COVID-19 claims was $6,707 during the first six months of medical treatment, compared with $2,617 for all other claims. For mild infections, average medical payments were $787 on COVID-19 claims compared with an average cost of $2,007 for a mild non-COVID injury. The average medical cost of a severe COVID-19 infection was $30,316, compared with average costs of $32,933 for a severe injury. Critical COVID-19 infections had an average medical payment of $71,717 compared with $91,235 for critical non-COVID claims. Death claims for COVID-19, meanwhile, involved average medical payments of $77,156 compared with average medical payments of $22,099 on non-COVID death claims.

This article was first published in Business Insurance.

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