Research Reports

California Public Self-Insureds Reported Fewer Claims in 2012, But Claim Costs Remained Near 10-Year High

The latest research on network provider utilization in California workers’ compensation shows network physicians delivered nearly 80% of first-year, physician-based outpatient treatment on AY 2010 claims.

New CWCI Research shows California workers’ comp claims that involve physician-dispensed repackaged drugs have higher average medical and indemnity payments and more days away from work than comparable claims with no physician-dispensed repackaged drugs.

New CWCI research shows compound drugs accounted for a declining share of prescription medications dispensed to California injured workers last year, yet compound drug payments continued to represent a growing percentage of prescription dollars.

A new Institute analysis suggests that allowing workers’ comp payers access to data from the state’s prescription drug monitoring program (CURES) would help reduce inappropriate dispensing of opioids in workers’ comp, improving injured worker treatment and saving an estimated $57 million in AY 2011 claim costs.

CWCI’s latest injury score card provides detailed data on California workers’ compensation carpal tunnel claims from accident years 2001 through 2011.

Updated figures from CWCI research show continued growth in average amounts paid for medical services in California workers’ comp, with payments for treatment, prescriptions and durable medical equipment, med-legal reports and medical management all trending up.

CWCI’s latest Injury Score Card provides detailed data and graphics on California work injury claims involving degenerative, infective and metabolic joint disorders. Members and subscribers may log in to view the full Score Card and summary Bulletin.

The latest CWCI Injury Scorecard takes a detailed look at California workers’ compensation claims involving shoulder, arm, knee, and lower leg sprains using data from 236,567 open and closed claims from AY 2001-2011.

An update to the CWCI analysis on the use of Schedule II painkillers in Calif workers’ comp suggests that that the use of these drugs peaked later than initially indicated, with revised data showing Schedule II opioids fell from a record 6.7% of workers’ comp prescriptions in the 2nd quarter of last year to 4.9% of the prescriptions in the 4th quarter.

The latest CWCI Injury Score Card examines head and spinal injuries without spinal cord involvement, which comprise only a small percentage of claims, but account for only a small percentage of California workers’ compensation claims, but a disproportionate share of paid losses.

Duplicate payments to hospitals allowed by the California Workers’ Compensation Official Medical Fee Schedule for implantable hardware used in spinal surgery added an average of $20,137 in fees to more than 3,350 work injury claims in 2010, boosting workers’ compensation medical costs by nearly $67.5 million

CWCI research measures the growing use of drug testing in California workers’ compensation, as well as the associated billings and payments.

Spine disorders with Spinal Cord or Root Involvement account for less than 1-1/2 percent of all California job injury claims, but nearly 7 percent of all workers’ comp paid losses. The latest CWCI Injury Score Card offers detailed data on these high-cost claims.

A new CWCI Report to the Industry looks at trends in California public self-insured claims experience using state data to track changes in public self-insured employers’ aggregate losses, average amounts paid and incurred per claim and claim volume over the past decade, with results measured at the first through 5th report levels. The Report is posted in the Research section.

Medical Back Problems without spinal cord involvement represent 1 in 6 work injuries and more than a 1/4 of all workers’ comp loss dollars. A new Injury Score Card provides detailed data on claims these medical back claims.

Use of medical networks in California workers’ compensation continues to grow, with new CWCI data showing that in AY 2009, network providers accounted for three-quarters of 1st year physician-based treatment and nearly 2/3 of the total paid for such services. The full study is in the Research section.

A new CWCI analysis of Calif. private self-insured employers’ paid and incurred loss data compiled by the state over the past decade finds that private self-insured claims experience closely tracks the experience of the insured market, with losses rising steadily from the late 1990s until the enactment of the 2002-04 reforms, after which they registered a sharp, but short-lived decline.

CWCI’s latest update on California workers’ compensation medical expenses shows that average amounts paid per claim continue to rise, as average payments for treatment, pharmaceuticals and DME, medical management and cost containment, and medical-legal fees all continue to trend up, though early results for AY 2010 claims suggest the rate of medical inflation may have slowed.