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Bob Young

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CWCI Scorecard Examines California WC Sprain Injury Claims

A new California Workers’ Compensation Institute (CWCI) “Injury Scorecard” offers detailed data on work injury claims involving shoulder, arm, knee, and lower leg sprains. The Institute compiled data for the Score Card from 236,567 open and closed California workers’ compensation claims from accident years 2001-2011 in which the primary diagnosis was a shoulder, arm, knee or lower leg sprain. As of January 2012, aggregate medical and indemnity benefit payments on those claims totaled nearly $2.4 billion.

The Score Card notes that during the 11-year study period, workers with these types of sprains accounted for 10.6% of California’s job injury claims, but only 1 in 7 of these injuries involved a permanent disability payment, they had a relatively low attorney involvement rate, and those that resulted in lost-time closed more quickly than other types of claims, so they accounted for only 7.8% of California workers’ compensation benefit payments. On the other hand, the Score Card reveals that while average paid losses on shoulder, arm, knee and lower leg clams were consistently below the average for all claims in California, as with other types of injury claims, in recent years the loss payments on these claims have moved up from their post-reform lows. For example, the latest data show that following the 2002-2004 workers’ compensation reforms, average payments at 36 months post injury on 2004-2006 sprain injury claims fell to $6,914 ($3,519 medical + $3,395 indemnity), but for 2007-2009 claims, that average jumped 10% to $7,600 ($4,167 medical + $3,443 indemnity). Similarly, among lost-time cases, average benefits paid at 36 months for sprain injury claims fell to post-reform low of $19,907 for 2004-2006 injuries ($9,248 medical + $10,659), but for 2007-2009 claims that average was also up 10%, climbing to $22,167 ($11,151 medical + $11,016 indemnity).

In addition to tracking average payments for 2001 through 2009 shoulder, arm, knee and lower leg sprain claims at 12-, 24- and 36-months post injury, the Institute’s latest Score Card features a profile of sprain injury claimants and claim distributions by industry sector, the claimants’ county of residence, and cause and nature of injury. Several exhibits also compare sprain injury claim results to those for all California workers’ compensation claims (these include exhibits showing the percentage of claims with PD payments within 3 years of injury; attorney involvement data; claim closure data; prescription drug distributions; breakdowns of medical development by Fee Schedule Section at 12 and 24 months post injury; notice and treatment time lags; and medical network utilization rates).

CWCI’s Injury Score Card Series and summary Bulletins are available to Institute members and research subscribers who log on to CWCI’s web site, www.cwci.org. Anyone wishing to subscribe to CWCI research and Bulletins may do so by visiting CWCI’s online Store. In addition to the latest Score Card on shoulder, arm, knee and lower leg sprains, recent Score Cards have provided detailed data on medical back problems with and without spinal cord or root involvement, and head and spinal injuries without spinal cord involvement. The next Score Card in the series will focus on claims involving degenerative, infective and metabolic joint disorders.