Last week, the New Hampshire Department of Insurance presented information about worker’s compensation medical costs in the Granite State.  This information came from the National Council on Compensation Insurance, or NCCI, which gathers data, analyzes industry trends and prepares objective insurance rate and loss cost recommendations from 35 states.

The information presented indicated that New Hampshire has some of the highest worker’s compensation costs in the country, especially medical costs.  Worker’s compensation surgical costs in our state are twice as expensive as the national average and 83 percent higher than the other New England states that submit data to the NCCI.  The analysis included four categories of physician services: surgical, radiology, physical and occupational therapies, and doctors’ visits.  Insurance department actuaries found that medical costs in New Hampshire exceeded those in surrounding states and the nation by a substantial margin in all four categories.  See the articles in the Union Leader and Concord Monitor.

In New Hampshire, there are no requirements for the use of evidence-based treatment guidelines for occupational injuries, as are used in other states such as Washington, New York, California, Massachusetts and Texas.  These guidelines have been adopted by many states in an effort to decrease medical costs and help improve outcomes such as return to work success.  Two of the guidelines often used are published by the American College of Occupational and Environmental Medicine (ACOEM) and the Work Loss Data Institute (Official Disability Guidelines).

One of the other options for addressing increasing medical costs for worker’s compensation is a fee schedule.  New Hampshire is one of six states, and the only state in New England, that currently does not use a fee schedule for worker’s compensation medical treatment.  The New Hampshire Medical Society does not support a fee schedule.  A prior legislative bill looking at this issue failed in 2012, and a bill this year looking at setting up a statewide commission to study this issue (HB 255) died in the Legislature a few weeks ago.

Hours after the Insurance Department released the NCCI data, Gov. Maggie Hassan announced the formation of a task force, which is made up of workers, members of the business community, insurers and healthcare providers, to look at this issue.  For those who may be involved in this task force, looking at choices and options found in other states may lead us in the proper direction.


Stuart J. Glassman, MD

Please send your questions or comments to or post a comment below.