EMPAQ
Metrics

About Workers' Compensation

Workers' Compensation (WC) provides coverage for medical expenses and wage replacement for employees disabled due to occupational injury or illness. WC expenses are typically associated with medical expenses, wage replacement payments, legal or investigative expenses, settlement costs or general expenses for claims administration. While workers' compensation is often thought of as similar to other disability coverage (i.e. short-term and long-term disability), it has several key differences:

  • WC is not considered an employee benefit but rather a property and casualty risk coverage, regulated differently by every state.
  • Wage replacement benefits can be supplemented by short-term and long-term disability benefits, but never the other way around. WC always pays first if the claim is work-related.
  • All states have WC laws dictating benefit amounts, how benefits are determined, claim management practices, funding arrangements, and ability to opt out of state plans.

For EMPAQ® purposes, WC focuses on only two types of claims: medical-only and indemnity.

EMPAQ® Metrics

EMPAQ® metrics are ratios (i.e. numerators over denominators) that can be used to calculate the effectiveness of health and productivity management programs. They establish a consistent method for measuring cost, utilization and other performance issues.

EMPAQ® WC Metrics

Click here for a copy of the EMPAQ® Data Dictionary, which contains detailed definitions of all of the metrics, data elements and plan design questions.

There are 20 EMPAQ® metrics that describe the cost and lost-time expenses arising from workers' compensation.

These metrics include information on indemnity and RTW claims. Indemnity claims refer to work-related injuries or illnesses involving time lost from work. Costs for indemnity claims include both medical care and wage replacement. Within the category of indemnity claims, there are four different types of lost time claims: Temporary Total Disability (TTD), Temporary Partial Disability (TPD), Permanent Total Disability (PTD) and Permanent Partial Disability (PPD).

Return-to-work (RTW) refers to those claims where an employee returns to work in a modified capacity after being disabled due to a WC-covered illness or injury. The employee may work reduced hours or be unable to complete their assigned duties. EMPAQ® RTW metrics help measure the utilization and effectiveness of RTW programs.

Cost Per Full-Time Equivalent (FTE) Metrics

Metric Ratio Explanation
Cost per FTE
Cost per FTE = Total Active Claim Costs

Total Number of FTEs
Covered for WC
This metric calculates the cost of WC per covered employee for a defined period of time.
Indemnity Cost per FTE
Indemnity Cost
per FTE
= Total Indemnity Costs for
Indemnity Claims

Total Number of FTEs
Covered for WCC
This metric calculates the indemnity costs for active WC indemnity claims per covered FTE.
Indemnity-Related Medical Cost
per FTE
Indemnity-Related Medical Cost per FTE = Total Medical Costs for
Indemnity Claims

Total Number of FTEs
Covered for WC
This metric calculates the medical costs for active WC indemnity claims per covered FTE.
Medical-Only Cost per FTE
Medical-Only Cost per FTE = Total Medical Costs for Medical-Only Claims

Total Number of FTEs
Covered for WC
This metric calculates the medical costs for active WC medical-only claims per covered FTE.

Claim Incidence Metrics

Metric Ratio Explanation
Annual Claim Incidence per 100 FTEs
Annual Claim Incidence per 100 FTEs = Total Number of New Claims

Total Number of FTEs
Covered for WC
× 100
This metric calculates the number of new claims per 100 FTEs incurred during a defined period of time.
Indemnity Claim Incidence per 100 FTEs
Indemnity Claim Incidence per 100 FTEs = Total Number of New
WC Indemnity Claims

Total Number of FTEs
Covered for WC
× 100
This metric calculates the number of new WC indemnity claims per 100 FTEs incurred during a defined period of time.
Medical-Only Claim Incidence per 100 FTEs
Medical-Only Claim Incidence per 100 FTEs = Total Number of New WC Medical-Only Claims

Total Number of FTEs Covered for WC
× 100
This metric calculates the number of new WC medical-only claims incurred during a defined period of time.
New Indemnity Claim Percentage
New Indemnity Claim Percentage = Number of New Indemnity Claims

Total Number of New WC Claims
× 100
This metric calculates the number of new indemnity claims incurred during a defined period of time.

Cost Per Active Claim Metrics

Metric Ratio Explanation
Cost per Active Claim
Cost per Active Claim = Total Active Claim Costs

Number of Active WC Claims
This metric calculates the per claim cost of WC coverage for a defined period of time.
Indemnity Costs for Indemnity Claims
Indemnity Costs for Indemnity Claims = Total Indemnity Costs for Indemnity Claims

Number of Active WC
Indemnity Claims
This metric calculates the indemnity costs per active WC indemnity claim.
Medical Costs for Indemnity Claims
Medical Costs for Indemnity Claims = Total Medical Costs for
Indemnity Claims

Number of Active WC
Indemnity Claims
This metric calculates the indemnity costs per active WC indemnity claim.
Medical Costs for Medical-Only Claims
Medical Costs for Medical-Only Claims = Total Medical Costs for Medical-Only Claims

Number of Active WC Medical-Only Claims
This metric calculates the medical costs per active WC medical-only claim.

Cost Per Closed Claim Metrics

Metric Ratio Explanation
Cost Per Closed Claim
Cost per Closed Claim = Total Benefits Paid for Closed
WC Claims

Number of Closed WC Claims
This metric calculates the total per claim cost of WC coverage for a defined period of time.
Indemnity Cost per Closed Claim
Indemnity Cost per Closed Claim = Total Indemnity Costs for Closed Indemnity Claims

Number of Closed WC Indemnity Claims
This metric calculates the indemnity costs per closed WC indemnity claim.
Indemnity-Related Medical Cost per Closed Claim
Indemnity-Related Medical Cost per Closed Claim = Total Medical Costs for Closed Indemnity Claims

Number of Closed WC Indemnity Claims
This metric calculates the indemnity costs per closed WC indemnity claim.
Medical-Only Cost per Closed Claim
Medical-Only Cost per Closed Claim = Total Medical Costs for Closed Medical-Only Claims

Number of Closed WC Medical-Only Claims
This metric calculates the medical costs per closed WC medical-only claim.

Lost Time Metrics

Metric Ratio Explanation
Lost TTD Workdays per 100 FTEs
Lost TTD Workdays per 100 FTEs = Lost Workdays for TTD Claims

Total Number of FTEs
Covered for WC
× 100
This metric measures the effect of lost productivity from WC indemnity claims.
Lost TTD Workdays per Closed TTD Claim
Lost TTD Workdays per Closed TTD Claim = Lost Workdays from Date of Injury for Closed TTD Claims

Total Number of Closed TTD Claims
× 100
This metric measures a company’s average number of lost workdays associated with closed TTD claims.

Return-to-Work (RTW) Metrics

Metric Ratio Explanation
RTW Claim Percentage
RTW Claim Percentage = Total Number of Claims with RTW Transitional Duty

Number of Total Active Claims
This metric calculates the percent of all WC claims with RTW transitional duty for a defined period of time.
RTW Transitional Workdays Percentage
RTW Transitional Workdays Percentage = Total Number of Workdays with RTW Transitional Duty

Number of Total Lost Workdays
This metric calculates the percentage of workdays that are lost due to transitional RTW for a defined period of time.


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