NCCI Finds Higher Medical Use in Older Workers’ Compensation Claims

Older claims carry higher average medical use

The rise in older workers’ compensation claims could change expected medical severity, but NCCI’s findings point to injury mix and treated health conditions as the main drivers of care. Claims involving workers 65 and older used 21% more medical care on average than claims involving younger workers, according to a report the National Council on Compensation Insurance released Wednesday. That gap is a useful signal for people tracking claim costs, but it doesn’t establish that age itself is the cause of higher utilization.

The distinction matters. An average describes a group of claims; it doesn’t tell an employer or insurer what will happen in any one case. A higher average could reflect more severe injuries, differences in the conditions treated during recovery, or the kinds of jobs workers do. NCCI’s account points to those factors as more direct explanations than age alone.

There’s a practical lesson in that framing: medical severity can shift as the composition of claims changes, even when the headline measure is simply the age of the injured worker. This is more significant than it looks, because a demographic trend can prompt closer scrutiny of expected care without explaining which claims account for the difference.

Older and women workers make up a larger share

The share of lost-time claims involving workers 65 and older doubled from 4% in accident year 2012 to 8% in 2025, NCCI said. Claims involving women also grew as a share of the total, from 33% to 36%. Those figures describe changes in the composition of lost-time claims. They don’t, by themselves, show that the number of claims, the cost of each claim, or the amount of care per claim rose by the same proportions.

That distinction is easy to lose when demographic figures are discussed alongside medical utilization. A larger share means that a group represents more of the claims being counted; it doesn’t prove why that share changed or how much it contributed to total medical spending. The report’s findings, as described here, offer context for assessing potential shifts in care, but they don’t isolate every cause behind the changing shares.

For readers comparing claims over time, the composition of the group matters. If the mix of ages, jobs, injuries and treated conditions changes, an average can move even when no single factor explains the movement. That’s why the increase among older workers is relevant to forecasting, but shouldn’t be read as a stand-alone measure of age-related cost.

Injury and job mix shape medical use

NCCI researchers attributed differences in medical utilization primarily to injury diagnoses, treated comorbidities and the kinds of jobs workers perform—not age or gender alone. A fall that leaves a younger worker with a bruise could cause a fracture in an older worker. The added care reflects the diagnosis and any health conditions treated during recovery, the report said.

The example shows how the same broad event can lead to different medical needs. The injury diagnosis gives a more direct account of the treatment required than a worker’s age by itself, while a health condition treated during recovery can also affect the care recorded on a claim. NCCI’s explanation therefore shifts the focus from demographic labels to the circumstances and treatment associated with each claim.

Job mix adds another layer. Workers in different industries may encounter different kinds of work and injury risks, so the balance of claims across jobs can influence average medical use. The report links gender differences in utilization to this distribution across industries and to the resulting injury mix. It doesn’t attribute the gap mainly to different care-seeking behavior.

Claims involving men averaged 28% more medical care than those involving women. NCCI linked that gap mainly to the distribution of men and women across industries and the resulting mix of injuries, rather than differences in care-seeking behavior. The figure is a group average, and the explanation is about how work and injuries are distributed across groups; it shouldn’t be treated as a prediction for an individual worker.

Here’s the thing: the averages can describe a real difference while still leaving the mechanism dependent on the claims inside them. If you're working in this space, the useful follow-up is to examine which diagnoses, treated conditions and job categories are contributing to utilization, rather than treating age or gender as a complete explanation. That’s where the report’s account offers more than a demographic comparison.

What the trend could mean for severity estimates

As workforce demographics shift, the mix of injuries and treated comorbidities may change too, with consequences for expected medical utilization and workers’ compensation medical severity. For people estimating future care, the report suggests that demographic composition is one part of the picture. The injury and treatment profile behind the claims also needs attention.

That said, the figures presented here don’t quantify how much of the 21% difference comes from diagnoses, health conditions, or job mix. They also don’t establish that the changing share of older workers will produce a particular future increase in medical severity. Those are important limits when translating a descriptive finding into a forecast.

Similar claims systems typically need to account for the characteristics of the claims being compared, because averages can reflect several influences at once. The NCCI findings point toward that kind of careful reading: observe the demographic change, then ask what care was delivered and for which injuries. And this is the part most people overlook: a bigger share of one group can matter to expected utilization without proving that group membership caused the difference.

For now, the reported pattern is clear enough to warrant attention, but its meaning depends on the underlying claim mix. Better estimates of medical severity will turn on whether the diagnoses, treated conditions and jobs represented in claims also change. The trend is a signal. Not a full explanation.