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Injury Classification in California Workers' Comp, Part 1: Medical Coding During the ICD-10 Transition

A new analysis on the use of ICD-10 codes in California workers comp during the transition from the ICD-9 system finds that 99 percent of submitted medical bills used ICD-10 codes and, as expected, a wider range of codes were provided than in the past, but many lacked the additional characters that better define the injury, identify the type of encounter and improve communication.

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CWCI IRIS Regional Score Card: Sierra Claims

Claims filed by workers living in the Sierras represent just 1.7% of California workers' comp claims, but over the past decade average loss payments in the region have grown faster than in other parts of the state. CWCI's final Regional Score Card takes a close look at key aspects of Sierra claims and compares the results to those from other regions.

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Spinal Fusion Claims in California Workers' Compensation

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

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IMR Decisions: January 2014 Through December 2016

A 12-page CWCI analysis that measures and compares IMR outcomes from 2014, 2015, and 2016.

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CWCI IRIS Regional Score Card: Claims from the Northern Counties

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.

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CWCI IRIS Regional Score Card: Central Coast Claims

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.

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CWCI IRIS Regional Score Card: San Diego County Claims

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.

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CWCI IRIS Regional Score Card: San Francisco Bay Area Claims

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.

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Cumulative Trauma in California WC

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.

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CWCI Report Looks at Implications of Legalized Marijuana on California WC

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.

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CWCI IRIS Regional Score Card: Central Valley Claims

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.

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CWCI Score Card Examines Inland Empire/Orange County WC Claims

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.

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California's Proposed WC Formulary: Preliminary Review of Preferred and Non-Preferred Drugs

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.

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California Workers Comp Regional Score Card: Los Angeles County

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.

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Impact of the RBRVS Fee Schedule

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.

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1st Quarter 2016 IMR Outcomes

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.

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California WC Claim Monitoring, Medical & Indemnity Development, AY 2005- 2014

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.

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Inpatient Hospital Utilization in California WC, 2008-2014

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.

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Independent Medical Review Decisions - January Through December 2015

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

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The Changing Nature and Cost of the Medical-Legal Process in California WC

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.

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