Q3 – 2021 – October 18, 2021
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Research Preliminary Cost Analysis of the New MLFS. CWCI’s analysis of initial data on the utilization and cost of Calif WC med-legal services in the first 2 months under the new MLFS (effective April 1) that changed the payment formulas for evaluations and reports found 56.7% of comprehensive M-L services from April and May were billed using only ML201 w/o charges for additional record review or reviewing surveillance footage. The median payment for these bills was $2,015, but the average paid was 12% higher at $2,257.60, due to additional fees for cases involving AMEs, qualified specialists, or interpreters. On the other hand, 43.3% of comprehensive evaluations had the $3 per page fees for reviews of additional records and/or time-based fees for reviewing sub rosa films. The median payment for these was $3,497.50, while the average payment was $4,951.36. Overall, CWCI found that in the first 2 months the median payment for all comprehensive M-L services under the new schedule was $2,216.50, and the average was $3,419.19. Under the old schedule, basic evals accounted for 40.9% of services, complex evals accounted for 18.4% and extraordinary evals accounted for 40.7%. Looking at the weighted average for all comprehensive M-L evals showed that under the 2006 MLFS these evals averaged $2,046.88, while under the new schedule they averaged $3,419.19, an increase of 67%. At the same time, payments for supplemental evals under the new MLFS were far less than the 67% increase noted for comprehensive evaluations, as average payments for follow-ups rose 11%, while average payments for supplementals rose 17.1%. The variability introduced by the new per-page fees and the unknown frequency of supplemental report requests made it difficult to project the ultimate cost impact of the new MLFS but given the 67% increase in comprehensive eval fees found in the preliminary data, it appears overall payments will increase beyond DWC’s targeted 25% increase. Executive Briefing (9/29/21) (members only) Bulletin (9/15/21) (members only) IMR Volume Continues to Decline. CWCI’s analysis of IMR volume and outcomes, based on 1.1 million IMR letters issued between January 2015 and June 2021 shows IMR volume continued to trend down in the first half of this year, as the economic slowdown and the declining number of Rx drug disputes under the MTUS formulary and the Chronic Pain/Opioid Guidelines contributed to the drop. CWCI tallied 68,044 IMR decision letters from the first half of 2021, down 3.3% from the first half of 2020, while the full-year letter count showed 136,738 IMR decision letters issued in 2020, down 16.6% from 2019 and down 26% from the record 184,735 letters in 2018. While IMR volume is down, UR physician modifications or denials of requested services continue to be upheld in about 9 out of 10 medical disputes sent through IMR. The overall uphold rate in the first half of 2021 was 91.2%, up slightly from 89.4% in 2020. Rx drug disputes, which accounted for half of all IMRs in 2015, represented 35.5% of the 2021 IMR decisions, and that share is down sharply from 2018. Rx drugs remain the #1 medical service category submitted to IMR, but the mix of services sent through IMR is gradually changing, with requests for PT, Injections, and DMEPOS all representing a growing share of IMRs since 2017. Together these 3 categories accounted for 35% of this year’s IMRs, w/uphold rates ranging from 90.8% to 94.4%. Among Rx drug IMRs, opioids have declined from 1/3 of the cases in 2018 to just over a quarter of the cases in the first half of 2021, even though 93% of UR doctors’ modifications and denials of opioid requests were upheld by IMR. With opioid IMRs down, other drug categories have seen their share of the Rx Drug IMRs increase — most notably musculoskeletal drugs, which comprise 18% of pharmaceutical IMRs despite a 98.4% uphold rate; dermatologicals, which are up to 16% of the drug disputes, and have a 94% uphold rate; and anticonvulsants, which represent 1 in 10 Rx drug IMRs, and have a 90.1% uphold rate. CWCI also has launched an IMR section on our website (click here) where members can access exhibits and CWCI summaries of quarterly IMR data. Executive Briefing (9/29/21) (members only) Bulletin (12/09/20) (members only) News Release (9/24/21) (public) DWP Hit an 8-Year Low in 2020. WCIRB’s report on insured experience through Q2 2021 showed DWP gross of deductible credit for 2020 was $14 billion, down $1.9 billion from 2019 and the lowest aggregate premium level since 2012. Premium volume has continued to decline this year, as DWP for the first half of 2021 was $7.0 billion, down 8% from the first half of 2020. The average charged rate per $100 of insured payroll in the first half of 2021 was $1.68, down 5% from the average charged rate of $1.77 in 2020 and the lowest charged rate in decades. WCIRB projected that insurers’ ultimate loss ratio, including COVID-19 claims, would increase from 68% of DWP in AY 2019 to be 73% of DWP in AY 2020; and that insurers’ ultimate combined ratio, including COVID claims, would increase from 96% in AY 2019 to 103% in AY 2020 which is up 24 points from the 14-year low hit recorded in 2016. Including COVID claims, indemnity claim frequency for 2020 increased 8% from 2019, with projected claim frequency continuing to increase in 2021, as both indemnity and med-only claim volume grew in the 2nd quarter as the economy reopened. Executive Briefing (9/29/21) (members only) COVID-19 Death Claim Trends and Characteristics. CWCI’s in-depth analysis of trends and characteristics associated with 1,032 California workers’ compensation death claims from the first 18 months of the pandemic. The report tracks changes in the number of COVID and non-COVID death claims from January 2020 through June 2021 as well as changes in the percentage of all death claims ascribed to COVID during that 18-month span and compares the distributions of COVID death claims vs. all COVID claims, and non-COVID death claims based on the workers age and gender, as well as by region and industry. Spotlight Report (9/10/21) (public) Executive Briefing (8/31/21) (members only) Bulletin (9/10/21) (members only) News Release (9/10/21) (public) Total DWP Declines 13% in Q1 2021. WCIRB’s quarterly report on insured experience showed Calif WC direct written premium for Q1 2021 was $3.6 billion, 13% below the pre-pandemic level of $4.2 billion recorded for Q1 2020. The decline reflected reductions in covered payroll and the average charged rate per $100 of payroll, which for Q1 was $1.74, 2% below the 2020 avg of $1.77, and 41% below the 2014 peak of $2.97 per $100 of payroll. WCIRB noted that indemnity claim frequency in 2020, including COVID claims, was up 8% from 2019, while excluding the COVID-19 claims, indemnity claim frequency was down 6.2% due to the pandemic-driven recession. The pandemic also affected claim closure rates, which fell sharply beginning in Q2 2020 and continued to decline through Q1 2021. After accounting for COVID-19 claims, WCIRB projected that the AY 2020 loss ratio would be up 5 points from the 2019 level while the combined ratio would increase from 95% in 2019 to 101% in 2020. The report notes that excluding COVID-19 claims, the projected combined ratio for 2020 would be 96%, nearly matching the 2019 combined ratio. Executive Briefing (8/31/21) (members only) MTUS Formulary Interactive Data Tool. An online application that shows the breakdown of medications within each version of the MTUS Prescription Drug Formulary by formulary category: Exempt, Non-Exempt, Not Listed; Special Fill, and Perioperative drugs. Users can identify which drugs were added to or dropped from the formulary and when; easily find where approximately 100 therapeutic drug groups and hundreds of specific drugs have been categorized; track changes in prescription and payment distributions among the formulary categories beginning with pre-formulary years (CY 2016 and 2017) and extending into the post-formulary years beginning with CY 2018; find the average wholesale price (AWP) and the average amount paid for specific drugs (by drug ingredient) over time; and view lists of the top 20 drugs by formulary category, broken out either by calendar year or by formulary version. Interactive App Update (8/30/21) (public) Delta Variant Spurs New Wave of COVID WC Claims. After trending down over the first half of 2021 and falling to a 16-month low of just 676 claims in June, the monthly tally of new COVID-19 claims in the California workers’ compensation system spiked to 2,581 cases in July, just shy of the combined total of 2,635 COVID claims recorded for the prior three months. That translates to a nearly four-fold increase in one month, the biggest monthly gain since COVID-19 claim volume hit its peak in December 2020. Claims with June and July injury dates were still coming in, but CWCI projections based on historical reporting patterns estimated that ultimately the COVID-19 claim count for July would hit 3,872 cases, or 4.8 times the projected total of 811 claims for June. Bulletin (8/13/21) (members only) News Release (8/13/21) (public) CWCI Claims Monitoring Interactive Tool. An interactive data application that shows average paid indemnity and medical losses on claims from AY 2006 through December of AY 2020 at 9 levels of development (with payments valued through December 2020). The tool provides results for indemnity claims or all claims, allows data to be viewed for specific industries and regions, and breaks medical payment data into medical treatment, pharmacy & DME, medical-legal services & medical cost containment expenses. Interactive Tool (7/30/21) (members only) Executive Memo (8/4/21) (members only) Executive Briefing (8/31/21) (members only) IRIS Regional Scorecard Interactive Tool. An interactive application based on updated IRIS data on AY 2007 through December 2020 claims from 7 different regions of the state that can be used to compare regional results to statewide data on key metrics, compare results between specific regions, and identify regional and statewide trends that have developed. Interactive Tool (7/30/21) (members only) Executive Memo (8/4/21) (members only) Executive Briefing (8/31/21) (members only) Prescription Drug Interactive Tool. An online application for examining and comparing industrywide pharmaceutical data derived from prescriptions dispensed to injured workers between January 2007 and December 2020. The tool can be used to view statewide or regional prescription data either for all claims or just indemnity claims; for open and/or closed claims; for specific drug groups; by opioid drug name; for generic and/or brand drugs; for specific industries; and for specific accident years or service years. Interactive Tool (7/30/21) (members only) Executive Memo (8/4/21) (members only) Executive Briefing (8/31/21) (members only) Private S-I Indemnity Claims & Losses in 2020. CWCI’s review of OSIP’s initial data on private self-insured employers’ 2020 WC claims noted that despite the pandemic, total private S-I claim volume edged up slightly last year, while sharp increases in indemnity claim frequency and avg indemnity/claim drove up total paid and incurred indemnity on private S-I claims. The increased incidence of indemnity claims/100 employees more than offset the decline in the M-O claim rate and with indemnity claims accounting for nearly half of private S-I claims in 2020, total paid losses for CY 2020 claims at the 1st report level rose to $252.8 million, as paid indemnity soared by $25.1 million (22.5%) while total paid medical fell by $9.5 million (6.7%). CWCI previously found that injured workers’ initial treatment was not materially delayed by the pandemic, but other factors may have contributed to the decline in paid medical and the big jump in paid indemnity w/in the 1st year (most of which was TD). These include delays in subsequent treatment and longer TD periods as payers and providers put off elective procedures and injured workers hesitated to seek care beyond telehealth as COVID was surging; an increased likelihood of work restrictions in the COVID environment; and a decline in the number of medical facilities available for procedures such as surgeries. Executive Briefing (7/23/21) (members only) Bulletin (7/20/21) (members only) News Release (7/21/21) (public) COVID Claims July 12 Update. The Delta variant hit Calif just after the state reopened, but the July 12 update to CWCI’s COVID-19/Non-COVID-19 App, showed COVID claims had yet to surge. After peaking in December, COVID claim volume plunged by 49.3% in January and continued to trend down through the first half of the year, with monthly tallies in May and June falling to just 668 and 453 claims respectively, which brought the pandemic total to 147,758 COVID claims, including 1,012 death claims. CWCI projected that ultimately there would only be 741 COVID claims for May and 612 for June but noted that despite the steady decline in COVID claim volume, prompt reporting had become a concern. A CWCI analysis of the timeliness of COVID-19 and Non-COVID-19 claim reporting (Bulletin 21-09) found that after COVID claims peaked in December 2020, the percentage of non-COVID claims reported to employers within 2 weeks of injury held steady at about 90%, but the percentage reported within 2 weeks had fallen from 95% in December to 65% in May. Likewise, the percentage of non-COVID claims reported within 30 days held steady at 93-95%, while the percentage reported within 30 days dropped from 99% 70%. The Institute found that the increase in delayed reporting was most prevalent among self-insured claims; claims from the agriculture, public safety/govt, administration and waste, and education sectors, and claims from rural areas and the Inland Empire/Orange County. CWCI noted the sharp drop in timely COVID reporting may be early evidence of the long-haul effect of COVID claims or changes in the level of attorney involvement, though if that is the case, those factors had not yet led to an increase in COVID-19 claim volume. Bulletin (7/14/21) (members only) Executive Briefing (7/23/21) (members only) Update on CY 2020 Paid Losses & Expenses. In late June WCIRB reported that Calif WC insurers’ paid benefits declined from $8.4 billion in 2019 to $7.9 billion in 2020: 53% of which ($4.2 billion) was for medical services, down from $4.6 billion in 2019, while 47%, or $3.7 billion, was for indemnity, down from $3.8 billion in 2019. At the same time, earned premium fell from $16.1 billion in CY 2019 to $14.1 billion last year – less than expected as covered payroll did not drop much as low-wage workers bore the brunt of layoffs and furloughs during the pandemic, while most high wage employees remained on the job. Insurers’ total incurred losses for 2020 were $7.1 billion, or 51% of earned premium, while incurred expenses totaled $4.9 billion, or 34% of earned premiums, with incurred loss adjustment expenses accounting for nearly 1/3 of those expenses ($1.7 billion, or 12% of earned premium). Bottomline: Calif WC insurers’ CY 2020 incurred losses and expenses were $12 billion, or 85% of the $14.1 billion of earned premium. Executive Briefing (7/23/21) (members only)
Statutory/Regulatory Member Alert: DWC Mistakenly Announces No WC Benefit Increases for 2022. On Sept. 15, a DWC Newsline announced that the State Avg Weekly Wage declined between Q1 2020 and Q1 2021, so there would be no change in TD rates and other WC benefits in 2022. Noting that the Q1 wage and employment figures were not yet available, CWCI contacted the DWC and issued an Exec Memo advising members that the Newsline was premature and, as noted in our July 23 Executive Briefing, data from the 3 other quarters used to calculate the SAWW indicated a sharp increase in the SAWW was in the offing. A phone call to the supervising actuary at the Dept. of Labor confirmed that the $1,164 SAWW figure for Q1 2021 posted on DOL’s data table was incorrect (the result of a programming issue) and understated the actual amount by hundreds of dollars. The DOL sent the Institute its preliminary Q1 2021 data which indicate a SAWW increase in the range of 13.5% rather than the decrease announced by DWC, which will require a record increase in the weekly TD rates and other WC benefits. CWCI issued a follow-up Exec Memo to advise our members’ claims and legal departments not to rely on the Sept. 15 Newsline for 2022 planning or programming, and after reviewing the numbers supplied by the DOL, DWC issued a Newsline announcing its error. Once DOL corrects its programming error and releases the final SAWW figure for Q1 2021, CWCI will confirm the exact amount of the 2022 benefit increases in an Exec Memo and Bulletin. Executive Briefing (9/29/21) (members only) Executive Memo (9/22/21) (members only) Executive Memo (9/16/21) (members only) Emergency Regs Allowing Virtual QME Exams Extended, But In-Person WCAB Hearings to Resume. On Sept. 13, the DWC announced that in an effort to move WC claims toward resolution and avoid delays, emergency regs that allow virtual qualified medical evaluations would be extended for 90 days (from Oct. 12 until January 10). The decision came despite the fact that few QMEs have restricted themselves to virtual exams and there is widespread agreement that orthopedic exams need to be conducted in person. The push for continuing virtual QME exams also seemed ironic – if not contradictory — given that it came less than 2 weeks after DWC announced that as of October 1 it was reopening WCAB district offices around the state for in-person hearings – a move that was widely panned in light of ongoing COVID concerns. DWC’s request to extend the emergency QME regs was sent to OAL with approval expected. Executive Briefing (9/29/21) (members only) 30-Day Public Comments on Proposed Changes to the WCAB Rules of Practice and Procedure regulations. CWCI’s written testimony on DWC’s proposed WCAB Rules of Practice and Procedure. 30-Day Public Comments (9/24/21) (public) August Legislative Update. The Assembly and Senate Appropriations committees advanced 2 WC bills prior to the end of the legislative session: AB 872 would extend salary continuation benefits in lieu of TD to more firefighters; SB 284 would expand the previously enacted PTSD presumption for certain first responders to cover additional peace officers and specified state employees. In addition, AB 404, which would have required the DWC to review the MLFS every two years and increase the conversion factor to match the increase in the most recent federal Medicare Economic Index, was held under submission by the Senate Appropriations Committee, which did not meet on the last day it could pass bills, so AB 404 will not advance in 2021, though it may be carried over to 2022. The Legislature had until Sept. 10 to pass bills, and the governor had until Oct. 10 to sign or veto legislation sent to him. CWCI scheduled release of its annual summary of all enacted WC legislation for Oct. 11, the day after the deadline for Gov. Newsom to sign bills. Executive Briefing (8/31/21) (members only) Member Alert: MTUS Guideline Updates. Two updates to the Medical Treatment Utilization Schedule that incorporate evidence-based guidelines addressing the treatment of COVID-19 and anxiety disorders and that were the subject of public hearings held via conference call in May and June took effect with little fanfare earlier this summer after the DWC published the orders adopting them on its website but did not issue a Newsline to alert the WC community. The Institute issued an Exec Memo to alert our member company claims and medical staff of the updates and posted the final versions of the regulations and all relevant documents under the Regulations tab on our website. Executive Briefing (8/31/21) (members only) Executive Memo (8/22/21) (members only) 30-Day Public Comments on the Proposed Copy Service Fee Schedule. CWCI’s written testimony on DWC’s proposed Copy Service Fee Schedule. 30-Day Public Comments (8/30/21) (public) SB 335 Fails to Get Out of Committee. On July 13, the Assembly Ins. Committee failed to pass SB 335, a controversial bill that would have: 1) reduced the time claims administrators have to investigate most WC claims from 90 to 45 days, and from 45 to 30 days for first responder presumption claims; 2) increased employers’ liability for medical benefits during the investigation period from $10K to $17K; and 3) increased penalties for unreasonable delays in the payment of compensation on claims for which a presumption applies. In May a CWCI Impact Analysis Report on the bill concluded that despite the intent to expedite claim investigations, it is unlikely that claims adjusters could unilaterally do so, as that would require a coordinated, cooperative effort among all parties. Cutting investigation times in half and increasing employer liability for medical care during the investigation period by 70% also would reduce access to care; increase provisional denials due to lack of cooperation or available documentation, the inability to schedule a QME, etc.; and would likely trigger litigation and increased ALAE and ULAE related to investigations. At its July 13 meeting, the Assembly Ins. Committee fell 1 vote shy of approving the reductions in investigation periods after the chairman announced plans to eliminate the provisions reducing the decision timeframes and said that without more evidence or data, the proposed increase in the penalty cap on presumption claims was unwarranted, especially since penalties would be paid by public entities, suggesting that state lawmakers may commission a study to examine the extent to which presumption claims are denied. Executive Briefing (7/23/21) (members only) Big Calif WC Benefit Increase Likely in 2022. Preliminary Dept. of Labor wage and employment data used to calculate the change in the State Average Weekly Wage and the annual change in TD rates suggest a big increase in WC benefits for 2022. Given that the pandemic began in Q1 2020, CWCI expected the Q1 2020 – Q1 2021 SAWW numbers would be skewed by the heavy loss of low-income jobs during the pandemic (and the higher %-age of the workforce made up of high-income workers), as well as the hazard pay provided to essential workers, increases in the minimum wage, and higher wages employers have paid to get employees back to work. That appears to be the case. CWCI’s review of data through Q4 2020 show that between Q1 and Q2 2020 covered employment in the state fell by 1.8 million jobs to 15.2 million workers, before rebounding to 16.22 million in Q4; yet total wages rose from $271 billion in Q1 to $304 billion in Q4. With the decline in the workforce and the increase in total wages, the SAWW went from $1,383 in Q1 2020 to $1,526 in Q4 2020. The jump in the SAWW received little attention, so it may not be on anyone’s radar, but if the trend continued in Q1 2021 – which is likely — this will have a big impact of WC payers, as the Q1-Q4 SAWW increase alone would push TD payments up by $140/week and require similar COLA increases in life pension and PTD payments. The Q1 SAWW figure due out in October will determine the full extent of the increase in WC benefits for 2022, but given the employment and wage trends, it appears that weekly TD rates and other benefits tied to the SAWW will rise sharply next year. Executive Briefing (7/23/21) (members only) Mid-July WC Legislative Update. CWCI noted several WC bills were alive as of mid-July: AB 1465 originally would have created a state-run WC MPN as an alternative to existing MPNs but was amended to instead request a study of delays and access-to-care issues in MPNs. The bill is pending before the Committee on Labor, Employment, and Public Retirement; SB 788 a CAAA bill to prohibit discrimination in apportionment based on race, religious creed, color, national origin, gender, marital status, sex, sexual identity, or sexual orientation. The Assembly removed language banning apportionment based on age or genetics before sending it to the Senate, which had yet to consider the amendments; AB 404, which would require the DWC to review the Med-Legal Fee Schedule every two years to adjust the conversion factor to reflect change in Medicare’s Economic Index; AB 334 would extend the skin cancer presumption for public safety officers to Dept of Parks & Rec and Dept of Fish & Wildlife peace officers. The bill was sent back to the Appropriations Committee: SB 284 would prospectively expand the previously enacted PTSD presumption for certain first responders to cover additional peace officers and specified state employees. Executive Briefing (7/23/21) (members only)
Legal CITY AND CO OF SAN FRANCISCO V WCAB (PACATTE). In a case now pending at the First District, the defense has asked to set aside a finding of compensability under the Special Mission exception to the going-and-coming rule. A firefighter driving his personal vehicle to his regular workstation as part of his daily commute was killed in a head-on collision. While it was possible for him to be called to duty at another location, the employee had not been reassigned since joining his current station house and was not expected to be reassigned on DOI. The defense position on appeal is that the employee is required to demonstrate that, on the actual DOI, a benefit to the employer existed and that the employee needed his car for work. CWCI filed an amicus curiae brief on behalf of the defense. Amicus Brief (10/12/21) (members only) SEE’S CANDIES V. SUPERIOR COURT (EK). CWCI joined an amicus brief filed with the Court of Appeal in a case that considers the question of whether a comp carrier has liability for a derivative injury in a COVID-19 claim. In this case, the employee alleges that she was infected with the virus at work and passed it along to her family. Her husband died from the disease, and the employee filed a claim for damages in Superior Court. The employer demurred under exclusive remedy, but the trial court overruled the demurrer. CWCI has joined the US Chamber of Commerce, CalChamber, and others as amicus curiae in the employer’s appeal. The Court of Appeal has issued an order requiring the Superior Court to show cause why a peremptory writ should not issue. Oral Argument was set for Nov 16. Amicus Brief (9/10/21) (members only)
Other Minutes from the Claims and Medical Care Committees Meeting. The meeting was held August 31 via Zoom. Ms. Secia began with a regulatory review including DEU and QME regs, which were in the Forum stage, MTUS low back guidelines, and WCAB rules of practice and procedure, for which 30-day comment periods were scheduled; and the copy service fee schedule regs, for which a 30-day public hearing was held. Recently adopted regs included MTUS guidelines for COVID and mental health, formulary updates, QME telehealth regs, and Cal/OSHA’s ETS for COVID. Ms. Secia advised that the DWC plans to post regs on UR, the interpreter fee schedule; and the home health fee schedule. Mr. Swedlow and Ms. David reviewed CWCI research on AB 1465 (CAMPN) and SB 335, which would have reduced WC claim investigation times; discussed an upcoming access to care study and CWCI’s recently updated interactive data tools, the update on IMR, and a preliminary analysis of the impact of the new MLFS. Ms. Secia reviewed several WC bills: AB 399 which proposed penalties related to MPN access and IBR late provider reimbursements, but was held over to the 2021-2022 session; AB 1465 the CAMPN proposal that now only calls for a CHSWC study; AB 334 which would extend the skin cancer presumption to peace officers in the Departments of Fish and Wildlife and Recreation; SB 335 which would have reduced claim investigation times but failed to pass out of committee; SB 788 CAAA’s bill to prohibit apportionment under §4663 based on race, religion, color, national origin, gender, marital status, sex, sexual identity, or sexual orientation; and SB 284 which would expand the PTSD presumption to additional peace officers and specified state employees. Ms. Langille provided an update on CWCI’s amicus activities in Applied Materials v. WCAB (D.C.), See’s Candies v. Superior Court (Ek), and CCSF v. WCAB (Pacatte) and reviewed information from CAAA’s summer convention. Dr. Rupali Das discussed evidence-based treatment guidelines, reviewed approaches for the management of chronic pain claims, and addressed COVID issues in WC, including vaccinations and long-term effects of the disease. The meeting concluded with an alert regarding CWCI’s projection of a double-digit increase in TD rates for 2022 due to current SAWW trends, and Ms. Secia’s review of LC 3550 issues. Meeting Minutes (8/31/21) (members only) Legal Committee Minutes. The August 12 meeting was held via Zoom. Ms. Langille noted that in the published decision in Applied Materials v. WCAB (D.C.), a 2013 psych injury was deemed a compensable consequence of a 2001 orthopedic injury, so the psych claim must be determined under the 2005 PDRS. She also provided an update on See’s Candies v. Superior Court (Ek), a case in which CWCI and the U.S. Chamber of Commerce have filed an amicus brief. The committee discussed the amicus counsel’s need for assistance from our membership, particularly as it relates to any related data, experience, or anecdotes that could be shared with the Court. CWCI’s Executive Committee determined that the Institute should not participate as amicus in Great Divide Ins. Co. v. WCAB (Banegas). The committee then reviewed two cases for amicus consideration: Mierczynski v. City of Fullerton (on the issue of Death Benefit calculation) and Pacatte v. City and County of San Francisco (in regard to the Going and Coming Rule). CWCI will file an amicus brief in Pacatte. Ms. Langille provided quick updates on the MTUS Drug Formulary, the MLFS, and the QME regs, as well as a review of pending legislation, including AB 399 (MPN/IBR), AB 404 (MLFS), AB 1465 (study bill), SB 335 (investigation periods and penalties), AB 1561 (Dynamex exemptions) and AB 788 (apportionment factors). Ms. Langille noted she will be on 2 panels: Case Law and Writing a Quality Report, at an upcoming CSIMS conference and asked for committee input. She also advised that under the new MLFS, modifiers for psychiatric, toxicology, or oncology are not applicable to AME evaluations — instead, the AME can bill at the increased AME rate, but not the additional specialty rate, which may impact AME availability in these specialties. It was noted that in-person trials at the WCAB may resume by October 1, and that new judges had joined the WCAB staff in San Francisco and in Oakland. It was also noted that CWCI expects a sharp increase in WC benefits in 2022 as the SAWW has been trending up over the last year. Several members of the committee who attended the CAAA convention in July shared their input on various workshops and Ms. Langille reviewed the latest COVID claims data which confirmed the major decrease in claims since December 2020, but the projection of a sharp increase in July in the wake of the Delta variant. Meeting Minutes (8/12/21) (members only) CWCI Quarterly Summary. Quarterly listings of all CWCI publications, including publication dates, brief summaries of each topic and the various formats in which the information is available (e.g., research report, Bulletin, Executive Briefing, news release), so users can choose the level of detail they want to view. Listings include live links so users can click into the CWCI website to access specific documents quickly and easily. |