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Medical Back – Score Card

The California Workers’ Compensation Institute has launched a new series of research publications, “California Workers’ Compensation Industry Score Cards,” which uses subsets of data from CWCI’s Industry Claims Information System (ICIS) database to measure various aspects of claims experience for injuries within 10 common diagnostic categories. Each Score Card will profile claimant characteristics and show the claim distributions for injuries within a specific diagnostic category broken out by industry sector, claim type (Medical-Only, Temporary Disability, Permanent Disability), common “nature” and “cause” of injury categories, and injured worker county of residence. Both the percent of claims and percent of loss payments are also broken out by ICD-9 diagnostic code. Many of the Score Card exhibits, including the percentage of claims with permanent disability payments within 3 years of injury; the attorney involvement data; the claim closure data; the prescription drug distributions; the breakdowns of medical development by Fee Schedule Section at 12 and 24 months post injury; the notice and treatment time lags; the medical network utilization rates; and the 12-, 24- and 36-month loss development tables compare the results for the specific injury category against the averages for all California workers’ compensation claims, providing a wealth of detailed data not only on claims within each injury category, but on the entire system.

The first Score Card in the series, released this week, focuses on claims involving Medical Back Problems without Spinal Cord Involvement – so-called “medical back claims” that consist primarily of back strains and sprains. The Score Card notes that these are among the most common work injuries in California, accounting for one out of every six work injury claims in the state and more than a quarter of total workers’ compensation paid losses.

The Institute plans to roll out the Injury Score Card series over the next several months, and all 10 Score Cards, along with summary Bulletins, will be available to CWCI members and research subscribers who log on to the Institute’s web site at www.cwci.org. Anyone wishing to subscribe to CWCI Research and Bulletins may do so by visiting the Institute’s online Store. The next Score Card in the series, scheduled to be released next month, will examine claims involving more serious back injuries: Spine Disorders with Spinal Cord or Root Involvement.