These worksheets provide detailed supplemental exhibits and analysis to the injury scorecard associated with degenerative, infective or metabolic joint disorders.
Research Reports
Estimate of Proposed Revisions to California’s 2-YearTemporary Disability Payment Cap
This analysis estimated total temporary disability benefits had the TD cap proposed by AB 338 been in effect for accident year 2000 and 2001 injury claims.
Injury Scorecard – Inflamed Muscles and Joints – Supplemental Exhibits
These worksheets provide detailed supplemental exhibits and analysis to the injury scorecard associated with inflamed muscles and joint
Injury Scorecard – Inflamed Muscles and Joints
The enclosed Score Card is the fourth in the ICIS injury series and provides detailed data and graphics on California work injury claims involving inflamed muscle and joint claims. These claims account for just 5% of California job injuries, but they can be some of the most complex and expensive workers’ compensation cases because the subjective and cumulative nature of the injuries often leads to reporting and treatment delays, attorney involvement, longer claim duration, and high indemnity costs.
Injury Scorecard – Spine Disorders with Spinal Cord or Root Involvement – Supplemental Exhibits
These worksheets provide detailed supplemental exhibits and analysis to the injury scorecard associated with spine disorders with spinal cord or root involvement.
Injury Scorecard – Spine Disorders with Spinal Cord or Root Involvement
The enclosed Score Card is the third in the ICIS injury series and provides detailed data and graphics on California work injury claims involving spine disorders with spinal cord or root involvement. Based on CWCI Industry Claims Information System (ICIS) data, these injuries account for just 2% of work injury diagnoses in California, but a high percentage of these injuries result in permanent disability, so they consume more than 8% of all payments, making them among the most costly workers’ compensation claims in the state.
MPNs and Medical Benefit Delivery-Preliminary Results
This analysis measured changes in the percentage of injured worker outpatient treatment visits to network providers by timeframe and type of medical service. The study examined provider-based medical treatment data from AY 2002 through AY 2005 claims.
Injury Scorecard – Shoulder, Arm, Knee and Lower Leg Sprains – Supplemental Exhibits
These worksheets provide detailed supplemental exhibits and analysis to the injury scorecard associated with shoulder, arm, knee and lower leg sprains.
Injury Scorecard – Shoulder, Arm, Knee and Lower Leg Sprains
The enclosed Score Card is the second in the ICIS injury series and provides detailed data and graphics on California work injury claims involving shoulder, arm, knee and lower leg sprains. Based on CWCI Industry Claims Information System (ICIS) data, these injuries are among the most common diagnoses in California workers’ compensation, and though they tend to cost less than other injuries, this CWCI Score Card shows that 1/3 of these sprain cases result in lost time, with total benefit payments averaging more than $19,000 after 2 years.
The Effect of SB 899 on Temporary Disability Benefits
This preliminary analysis on the effects of recent California workers’ compensation reforms shows that reform may be associated with lower TD payments, fewer paid TD days, faster injury reporting, and faster claim closure. Under the 2004 reform bill (SB 899), ultimate TD payments will take at least two years to develop, so the authors urge caution in interpreting and applying these preliminary results.
Injury Scorecard – Medical Back Problems without Spinal Cord Involvement – Supplemental Exhibits
These worksheets provide detailed supplemental exhibits and analysis to the injury scorecard associated with medical back problems without spinal cord involvement.
Injury Scorecard – Medical Back Problems without Spinal Cord Involvement
The enclosed Score Card is the first in the ICIS injury series and provides detailed data and graphics on California work injury claims involving medical back problems without spinal cord involvement. Based on CWCI Industry Claims Information System (ICIS) data, these are the most commonly diagnosed work injuries in California, and though treatment plans for these injuries rely heavily on physical medicine and less invasive types of care, a high proportion of these claims result in lost time and litigation, as well as above average costs.
Medicare Reimbursement Models for Evaluation and Management Services
This study estimated the impact on California workers compensation medical payments in 2005 had the Official Medical Fee Schedule reimbursements for evaluation andmanagement (E&M) office visits been set at 2006 Medicare rates.
Medical Utilization & Reimbursement Outcomes
The goal of this study was to measure the associations between the California workers’ compensation medical care reforms implemented in 2004 – most notably, mandatory utilization review, the ACOEM guidelines, and the 24-visit caps on physical therapy and chiropractic care – and changes in the amount of treatment provided to injured workers, and the associated medical reimbursements.
Medical Care Reform & Access to Medical Care
This study considers the association between two managed care reforms -the adoption of the 1993 Medical Legal Fee Schedule and the 2004 Utilization Review Schedule – and changes in access to workers’ compensation medical services. Using a sample of more than 900,000 claims from injured workers treated between 1993 and 2005 — before and after implementation of the medical reforms — the study measures the workers’ proximity to a choice of three active providers who saw injured workers in each corresponding calendar year. The findings show that implementation of managed care controls was not associated with a material change in access to a choice of medical providers.
Impact of Physician-Dispensing of Repackaged Drugs on California Workers’ Compensation
Physician-dispensed prescription drugs comprise a significant portion of all pharmaceutical prescriptions dispensed in California’s workers’ compensation system. Because of limits on the reach of statute and regulations adopted under Senate Bill (SB) 228, physician-dispensed pharmaceuticals are also much more expensive than the same drugs dispensed through a pharmacy. This report, prepared for the Commission for Health and Safety for Workers’ Compensation, documents the extra costs placed on the workers’ compensation system by physician-dispensed drugs. The report also reviews research on both the positive and negative impacts of physician dispensing.
Effect of AB 749 TD Increases on 2/3 Wage Replacement
This analysis estimates the proportion of California injured workers who are paid temporary disability and receive at least 2/3 wage replacement, and how the proportion has changed since the AB 749 TD rate increases took effect in 2003, 2004, and 2005?
Changes in Inpatient Hospital Fee Schedule Allowances
This evaluation measured changes in the average amounts allowed under the California workers compensation inpatient hospital fee schedule for hospital stays for 2002, 2003 and 2004.
Changes in Medical Utilization and Average Cost by Medical Service Type
This analysis measured changes in medical utilization and reimbursement by type of medical service at the early stages of medical claim development subsequent to the California workers’ compensation reforms of 2002 – 2004.
Changes in Prescription Drug Utilization and Accessibility Following Adoption of the California Workers Compensation Pharmacy Fee Schedule
This analysis measured changes in the utilization, reimbursement and accessibility of prescription drugs in California workers’ compensation following the revisions to the pharmacy fee schedule that were effective on January 1, 2004.