Medical care accounts for 60% of the total cost of workers compensation claims. Claims that payers under invest in medical intelligence, thereby allowing medical errors and sub-optimal treatment to happen more than they need to be. However, structural, system-wide factors are behind some of the persistent problems in clinical practice. Systemic problems persist in making assessments of work causality of injury and in estimating permanent impairment. States have since the early 1990s erected a complex structure of managed care practices, however, they are flawed in a number of ways, and claims payers fail to implement them as comprehensively as they could. Claims are in a position to invest more in medical intelligence to encourage and facilitate improvements in clinical practice .