A recent report on the prevalence of “mega claims” in the workers’ compensation system revealed that, nationwide, such claims are at a 12-year high. A mega claim is one that reaches a minimum threshold of $3 million, $5 million or $10 million, depending on the definition used by each state’s rating bureaus.
Why would mega claims be so prevalent? Are people being hurt more severely? Or are medical advances and the high cost of home health care responsible for driving these claims up? Unfortunately, it’s unclear why these claims are so high.
All in all, about 4,500 mega claims occurred on injuries that took place between 2001 and 2017. Mega claims made up about one out of every 2,500 reported claims overall. Of mega claims reported, the majority were in the $3 million to $5 million category.
Construction claims are the most likely to be mega claims
Construction injuries made up 37% of claims between $3 million and $5 million and over 40% of claims between $5 million and $10 million or above $10 million. This is especially interesting because construction claims only account for about 20% of overall claims in most states.
The researchers categorized the cause of these injuries as:
- Motor vehicle accident
- Struck by an object
- Other causes, including amputation, burns, electrical shock, strain/sprain and cumulative injury
In this report and over time, fall/slip injuries were the leading cause of mega claims. The common accident type was the source of 35% of all mega claims.
Some mega claims aren’t apparent immediately
The report found that many mega claims aren’t obvious right away. Many catastrophic injuries take years to fully develop. Indeed, when it came to mega claims, less than half had been recognized as such by 18 months. The researchers attributed this to developments that can occur later in the claims process, such as a failed procedure that requires revision surgery.
What injured people need to know about mega claims
If you have been hurt at work, it could be very serious — even more serious than you may realize at first. Even a slip or a fall from a high place could result in severe or even catastrophic injuries that could change or increase in severity over time.
Even if your injury results in a mega claim, it should still be covered by workers’ compensation. There are generally no upward limits on the cost of these claims.
That said, the workers’ comp insurer may resist paying these claims fully. If you believe an insurance company is trying to underpay your claim, talk to an experienced workers’ comp attorney.