Research Reports

CWCI’s analysis of the utilization trends, costs, and characteristics of spinal fusion claims in California workers’ compensation.

Claims filed by residents of Californias nine northern most counties comprise 1.1% of the state’s work force, but 3.3% of the states workers’ comp claims and 2.2% of paid losses. CWCI’s seventh IRIS Regional Score Card offers detailed data comparing key aspects of claims from the Northern Counties to those from other regions.

Claims filed by workers living on the Central Coast account for 6.7% of all workers’ comp claims in the state and 6.3% of paid losses. CWCI’s sixth IRIS Regional Score Card offers detailed data comparing key aspects of Central Coast claims to those from other regions.

Claims filed by San Diego County residents account for 8.1% of all workers’ comp claims in the state, but only 6.2% of paid losses. CWCI’s fifth IRIS Regional Score Card offers detailed data comparing key aspects of San Diego County claims to those from other regions.

Residents of the 9-county San Francisco Bay Area account for 17.5% of all California workers’ comp claims but 15.4% of paid losses. CWCI’s fourth IRIS Regional Score Card provides detailed data comparing key aspects of Bay Area claims to those from other regions.

A new CWCI study provides a detailed data on California workers compensation cumulative trauma (CT) claims, identifies characteristics that differentiate CT claims from non-CT claims, and finds the high cost of CT claims is strongly associated with high levels of attorney involvement and the high incidence of CT claims in the L.A. Basin.

With the passage of Proposition 64, California voters approved the use of recreational marijuana in the state. This CWCI analysis examines the intersection of workers’ compensation with medical and recreational marijuana laws in California, in other states, and at the federal level.

Central Valley residents account for 18% of all California workers’ comp claims but 15% of paid losses. CWCI’s third IRIS Regional Score Card provides detailed data comparing key aspects of Central Valley claims to those from other regions.

Inland Empire/Orange County residents account for 19% of all California workers’ comp claims and 21% of paid losses. The regional Score Card provides detailed data comparing key aspects of Inland Empire/Orange County claims to those from other regions.

A CWCI Spotlight Report that uses data on 1.2 million prescriptions dispensed to California injured workers in 2014 to model the impact of the proposed WC prescription drug formulary released by the DWC on August 26, 2016.

L.A. County residents account for 25.6% of all claims in the state, but 31.9% of workers’ comp loss payments. What makes L.A. claims different? The Regional Score Card provides detailed data comparing key aspects of Los Angeles County Claims to those from other regions of California.

A detailed analysis of changes in the utilization and reimbursement of California workers’ comp physician and non-physician medical services during the first 2 years of the transition to the RBRVS fee schedule, which began in January 2014.

A new analysis of California workers’ comp IMR decisions from Q1 2016 shows little change in the number of IMR determinations, the percentage of UR modifications and denials upheld by IMR physicians, the types of medical services reviewed, and the high concentration of disputed medical service requests linked to a relatively small number of physicians.

New CWCI research that tracks average California workers’ comp medical loss, indemnity benefit and medical cost containment (MCC) payments on AY 2005 – 2014 lost-time claims finds mixed results, with more developed data on older claims showing paid medical losses and indemnity leveling out or declining, and less developed data on newer claims indicating that average amounts paid in the early stages of a claim are on the rise.

CWCI study quantifies reductions in WC, Medicare, Private Plan and Medi-Cal inpatient hospitalizations since 2008, identifies the most common WC inpatient diagnosis-related group codes (MS-DRGs); calculates average charged and paid amounts for the top 10 WC inpatient MS-DRGs; and measures changes in the volume of implant-eligible spinal surgeries and in the proportion of spinal fusion MS-DRG discharges to total discharges across time for each payer group.

A detailed analysis on IMR outcomes, including decision counts and uphold rates, based on data gleaned from 2015 IMR determination letters

A CWCI study reviews statutory, regulatory and judicial changes to the California workers’ comp medical-legal process over the past quarter century, provides updated data on the quantity, mix and cost of medical-legal services following the 2002-04 reforms, and generates benchmark data for future research on the impact of the 2012 reforms, which introduced IMR as the new means for resolving treatment disputes.

New CWCI research based on 2014 UR data and IMR determinations from the first half of 2015 shows an estimated 96 percent of medical services in California workers’ comp are approved.