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52. High Cost Claims

Description: This report provides a listing of open/active claims which have an estimated total liability of over $10K.  The claims are identified in broad total liability categories and are listed in descending order of total liability.

Access Level Required: Case Management Detail Level Access.

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Benefits: Focuses on high cost claims which impact significantly on premiums, so that appropriate action to contain these costs can be initiated.

Parameters: This report represents open claims that have an estimated liability over $10,000.

Fields Description
Case Mgr Name The name of the employee within the claimants agency looking after the claim.
CTD + FCE ($) Stands for Cost to Date + Future Cost Estimate. Distinct from 'Total Costs' because it includes incurred up to yesterday in addition to the estimate formulated on the case estimate date.
Employee Name The name of the injured employee.
Claim Number The unique number that identifies a claim.
Date of Injury The date that claimants injury occurred.
Mechanism of Injury Major Group Refers to the classification groups within the Type Of Occurrence Classification System.
Liable cost centre No. The number of the liable cost centre where the employee was injured. This can be cross referenced with report 22. Liable cost centres are supplied by the customer and the level of detail is dependant on the customers reporting needs.
RTWP Status This indicates the current Return to Work Plan Status of the claim. The valid values for this field are: O = There is currently an open RTWP for this claim. C = There is a closed RTWP for this claim. N = There is no RTWP registered for this claim
Medical CTD($) This is the total cost to date of Medical payments made on this claim.
Incap CTD($) This is the total cost to date of Incapacity payments made on this claim.
Rehab CTD($) This is the total cost to date of Rehabilitation payments made on this claim.
Travel CTD($) This is the total cost to date of Travel payments made on this claim.
Other CTD($) This is the total cost to date of all other payments not already defined on this claim.
Total CTD($) The total costs of all payments made on this claim.

Notes: These high cost claims are those most likely to have a significant impact on premiums. The report re-directs attention to the Return to Work Plan (RTWP) status for each claim. Where the status is C (closed) or N (no RTWP registered for claim) agencies may consider developing a RTWP in an endeavour to reduce further incapacity and resultant costs.

The report includes claims data relating to an agencies current employees. In some cases liability for specific claims may rest with a former or other employer. It also includes pre-premium claims.

Page last updated: 20 Mar 2014