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Facts About Workers' Compensation, Rev. 9/15

Basic information about coverage, benefits and medical care under the workers' compensation program. Approved by the Administrative Director of the Division of Workers' Compensation for complying with statutory provisions of Labor Code Section 3551 and California Code of Regulations Sections 9880 and 9883 (Spanish), which require employers to furnish all new employees with state-approved, written notice of their right to workers' compensation benefits. Includes DWC-approved language reflecting changes enacted in SB 863, including updated information regarding PD, SJDB, the Return to Work Fund, as well as the optional forms for physician predesignation and naming a personal chiropractor which were revised 7/1/14, and changes to the benefit notice regulations that took effect 1/1/16. New hire pamphlet.

English, sets of 100 for $20.00
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Spanish, sets of 100 for $20.00
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Facts For Injured Workers, Rev. 9/15

Information explaining coverage, the nature of benefits and how they are secured, the medical treatment system and what to do if a problem arises. Designed to provide written information to injured workers about their rights and obligations under California workers' compensation. Includes language updated for 2016 to reflect SB 863 changes and changes to the benefit notice regulations that took effect 1/1/16 and current information regarding PD, SJDB, the Return to Work Fund, and physician predesignation, as well as new TD rates for injuries on or after 1/1/16. Can also be used to meet Ins. Code 1871.8 notice requirement on fraudulent receipt of TD and LC 3553 notice requirement for victims of workplace crime.

English, sets of 100 for $20.00
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Spanish, sets of 100 for $20.00
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If A Work Injury Occurs..., Rev. 9/15

Posting notice containing the general workers' compensation benefit information required by state law, with DWC-approved language reflecting changes enacted in SB 863 and changes to the benefit notice regulations that took effect 1/1/16, including current information regarding PD, SJDB, the Return to Work Fund, and physician predesignation. This posting notice has been approved by the Administrative Director of the DWC for satisfying employer notice requirements of California Labor Code Section 3550 and California Code of Regulations Sections 9881 and 9883.

English - Paper Copies, sets of 100 for $29.00
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English - Single Copy on Cover Stock for $6.00
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Spanish - Paper Copies, sets of 100 for $29.00
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Spanish - Single Copy on Cover Stock for $6.00
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Workers' Compensation Claim Form (DWC-1) & Notice of Potential Eligibility, Rev. 1/16

New 6-part claim form/NOPE, effective 1/1/16 --- Note: MUST be used beginning 1/1/16

The form that injured workers, their dependents or agents use to file a claim for workers' compensation benefits in California (LC 5401, CCR 10139.) This form was revised by the state in September 2015 and took effect 1/1/16. Changes include a new 3-page Notice of Potential Eligibility as well as revisions to the DWC-1 claim form. California law requires employers to provide employees with the DWC-1 form and Notice of Potential Eligibility within one working day of receiving notice or knowledge of a work injury or illness (beyond first-aid.) The 6-part form is printed in English and Spanish, with the state-mandated Notice of Potential Eligibility printed as a cover sheet attached to four copies of the claim form printed on NCR paper: one as the employee's temporary receipt when they first file the claim; and one each for the employer and the claims administrator, and one as the employee's final copy that should be signed and dated by the employer after completing their portion of the form (new 6-part claim form/NOPE, effective 1/1/16.)

sets of 100 for $48.00 (bulk discount available)
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California Workers Compensation IRIS Regional Score Cards (NEW)

CWCI’s Industry Research Information System (IRIS) Scorecards analyze various aspects of accident year 2005-2015 claims experience within 8 different regions of California. Each Score Card profiles claimant characteristics and highlights data compiled from claims filed by residents within the specific region. Exhibits include distributions of claims broken out by industry sector, premium size; claim type (medical-only, temporary disability, permanent disability); common "nature" and "cause" of injury categories; and primary diagnoses. Several exhibits, including the percentage of claims with permanent disability; attorney involvement rates; claim closure rates; calendar year 2014 prescription drug distributions; breakdowns of medical development by Fee Schedule Section at 12 and 24 months post injury; medical network utilization rates; notice and treatment time lags; and 12-, 24- and 36-month loss development tables compare results for the specific region against those for all other regions. Many also provide the combined statewide results, offering a wealth of detailed data not only on claims experience for the given region, but for the entire state.

Central Valley Claims, 10/16 for $27.00
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Inland Empire/Orange County, 10/16 for $27.00
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Los Angeles County, 08/16 for $27.00
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Independent Medical Review Decisions - January Through December 2015 (NEW)

A research report spotlighting the 2015 outcomes of the independent medical review process used to resolve medical disputes in the California workers’ compensation system. Results show changes in the volume of IMR determination letters and the processing time by month for 2014 and 2015; the average number of medical service decisions per letter issued in 2015; and the number of decisions and the uphold/overturn rates by type of service requested (including results for prescription drug IMRs by drug type), year of injury, region and top providers.  (Spotlight Report, 02/16)

$24.00
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Impact of the RBRVS Fee Schedule on California Workers Comp Physician & Non-Physician Practitioner Service Payments

A detailed analysis of changes in the utilization and reimbursement of California workers’ compensation physician and non-physician medical services during the first two years of the transition to the Resource Based Relative Value Scale (RBRVS) fee schedule, which began in January 2014. The report provides background information on the transition to the new schedule, then uses data on 11.4 million medical services rendered in 2013, 2014, and 2015 to measure changes in service volume and total amounts paid by medical service category, the percent change in unique claims by service category, the changes in the weighted average payments for each of those 8 categories and overall, the resulting redistributions of medical services and payments governed by the RBRVS fee schedule, as well as the change in the average paid per date of service per service category. In addition, the report identifies the top 10 services in the 8 fee schedule categories for service years 2013, 2014, and 2015, based on the total volume and payments, then notes the changes in the payment and service distributions, the rankings of the top 10 services and the amounts paid per code. (Report to the Industry, 08/16)

$36.00
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Inpatient Hospital Utilization in California WC: 2008-2014 (NEW)

An analysis of inpatient services and procedures in California workers’ comp vs. Medicare, Medi-Cal and private coverage, based on a review of OSHPD discharge data and payment data from CWCI’s IRIS database. In addition to quantifying reductions in workers’ compensation inpatient hospitalizations in 2014 and over the past 7 years, the study identifies the 10 most common inpatient diagnosis-related group codes (MS-DRGs) in California workers’ comp for 2013 and 2014; calculates average charged and paid amounts for the top 10 workers’ comp 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. (Spotlight Report, 03/16)

$19.00
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2016 California WC Case Law Update Seminar Manual

The course syllabus from CWCI's May 2016 seminar on recent California workers’ compensation case law. The syllabus is broken into sections that include brief summaries (with full citations) covering decisions related to Medical Treatment, Medical Treatment Dispute Resolution, Permanent Disability & Apportionment, and decisions related to other topics which are included in a “what’s new” section.

$30.00 ($25.00 for members)
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Bulletins & Research Reports Subscription

CWCI publishes Bulletins highlighting the latest research results and addressing current issues and events affecting the California workers’ compensation community. Bulletins and CWCI research reports are available to nonmembers on a yearly subscription basis.

Email & Web Access for 12 months for $119.00
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Postal Delivery for 12 months for $129.00
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Bulletins, Research Reports and Significant Decisions Subscription

CWCI publishes both bulletins highlighting the latest research results and significant regulatory decisions affecting the California workers’ compensation community.  This subscription combines both the Bulletins and CWCI Research Reports subscription with the Significant Decisions subscription and is available to nonmembers on a yearly basis.

Email & Web Access for 12 months for $139.00
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Postal Delivery for 12 months for $159.00
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California WC Independent Medical Review: 1st Quarter 2015 Outcomes

This study measures the volume of independent medical review (IMR) decisions generated in the 1st quarter of 2015, as well as the number of injured workers, utilization review (UR) events, and medical services associated with those reviews, and the percentage of the medical service requests that were modified or denied by a UR physician that were subsequently upheld by the IMR physician. In addition, the study identifies the month-to-month trends in IMR-eligible applications and determination letters for the 15-month period of January 2014 through March 2015; the number, mix and uphold rates of the 1st quarter 2015 IMR decisions by the type of medical service requested; the percent of all IMR determination letters issued in the 1st quarter of 2015 that were linked to the top 10 percent of high-volume physicians; and the proportion of 1st quarter determination letters and treatment decisions that involved the 10 individual physicians with the highest number of disputed medical service requests. The study also shows the distribution of IMR determinations by region and the areas that had a disproportionately high or low number of treatment disputes relative to their workers’ compensation claim volume. (Spotlight Report, 07/15)

$20.00
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Changes in Physician Reporting Under the RBRVS Fee Schedule: Initial Results

Changes to the Official Medical Fee Schedule (OMFS) mandated by SB 863 were expected to impact physician reporting in work injury cases. This analysis provides an initial look at physician reporting in the wake of the 2012 reforms and the changes in physician report billing codes. The research compares the volume, distribution and reimbursement of physician reports from the 1st quarter of 2014 to 1st quarter data from each of the three prior years, linking the reduction in the average amount paid for all reports to the changes in the underlying Evaluation and Management services that were introduced with the adoption of the RBRVS fee schedule rather than a decrease in the fee schedule amounts assigned to report code. The study also documents a reduction in the average number of reports per claim, which it suggests is likely due to the elimination of separate reporting associated with consultations and prolonged services.

(Research Update, 01/15)

$20.00
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ICD-10s and the WC System

On October 1, 2015, the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) became the standard classification system for all healthcare delivery in the United States, supplanting the outdated ICD-9 system. The transition to ICD-10 codes affects group health, federal programs (Medicare, Medicaid, Veterans Administration), as well as workers’ compensation. In the California workers’ compensation system alone, the changes in databases, data transfer protocols and business processes have affected medical service providers, medical bill payers, Utilization Review Organizations, Independent Medical Reviewers, Independent Medical Examiners/Qualified Medical Examiners, the state’s workers’ compensation reporting system, Medicare Set-Aside reporting and public policy research databases. This report reviews the history, the form and the function of the new classification system and outlines the similarities and significant differences in the ICD-9 and ICD-10 coding structures. (Spotlight Report, 09/15)

$20.00
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PPO to MPN: Impact of Physician Networks in California WC

A research report that examines the changes in the use of physician networks in California workers’ compensation as they evolved from Preferred Provider Organizations (PPOs) to Medical Provider Networks (MPNs) and measures their impact on medical costs associated with work-related injuries. Using data compiled from more than 1.8 million claims from accident year (AY) 2000 through June of AY 2011, the report compares the average medical benefit payments at 24 months post injury for claims where treatment was delivered by network providers to claims where treatment was delivered by non-network providers. In addition, the study documents changes in network utilization over the 11.5 year span of the study, and compares the changing nature and characteristics of claims where treatment was managed inside and outside of networks.

(Research Note, 06/15)

$35.00
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The Changing Nature and Cost of the Medical-Legal Process in California WC -- (NEW)

An Institute analysis that that reviews the legislative reforms, regulatory changes and judicial decisions that have reshaped the medical-legal process for resolving workers’ compensation claim disputes over the past quarter century; provides an update on the quantity, mix and average payments for medical-legal services in the wake of the 2002-2004 reforms; and generates benchmark data for use in future studies on the impact of the 2012 reforms, which introduced independent medical review as a new means for resolving treatment disputes. (Research Note, 02/16)

 

$35.00
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Significant Decisions Subscription

CWCI publishes reports concerning significant regulatory decisions affecting the California workers’ compensation community.  This subscription makes the Significant Decisions subscription available to nonmembers on a yearly basis.

Email & Web Access for 12 months for $59.00
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Postal Delivery for 12 months for $69.00
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