Q3, 2015 – September 30, 2015
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Research ICD-10s and the Workers’ Compensation System. An examination of the history, form and function of the ICD-10 classification system for healthcare delivery which takes effect October 1 for all health care systems in the U.S., including California workers’ compensation. CWCI Spotlight Report (9/29/15) (members only) Bulletin (9/29/15) (members only) News Release (9/29/15) (public) Growth in the Cost and Utilization of Drug Testing in California Workers’ Compensation. A preview of upcoming CWCI research that quantifies the increased use and cost of urine drug testing of injured workers, which has grown dramatically as the use of opioid painkillers has increased over the past decade. Executive Briefing (9/23/15) (members only) Insured Experience through 2Q 2015. A summary ofWCIRB’s report on insured experience through 2Q 2015. Key takeaways: DWP for the first half of 2015 was $8.9 B, roughly 9% above total DWP for the first half of 2014; avg charged rate/$100 of payroll for policies incepting in the first half of 2015 was $3.01, about 1% above the avg rate charged for 2014 and up 43% since 2009, but 52% below the all-time high from the last half of 2003; estimated ultimate losses and ALAE for AY 2014 claims are projected at $12.8 billion, up 7% from AY 2013 and 29% from 2009, but still below the record levels of a decade ago; estimated ultimate loss ratio for AY 2014 is 62% of DWP, while the loss adjustment and other expense ratio combined ratio is projected at 42%, for an estimated ultimate combined ratio of 104%. Executive Briefing (9/23/15) (members only) Insured Claims Experience Through Q1 2015…WCIRB data on insured claims experience through Q1 2015 shows CY 2014 total DWP gross of deductibles rose 11% to $16.5B as both payroll and insurers’ projected avg charged rate increased. Total DWP for 2014 was up 88% from the ’09 low. The charged rate for the Q1 2015 was $3.09/$100 of payroll (+4% from the 2014 and +49% from 2009), while total DWP for Q1 2015 is projected at 4.8B, up 9% from the same period last year. Ultimate losses and ALAE for AY 2014 are projected at $12.9 B, up 7% from AY 2013 and 30% from AY 2009, but below highs noted prior to the ’02-’04 reforms. Ultimate medical losses – including medical cost containment – are projected to fall for the 3rd year in a row in AY 2014, but ultimate indemnity losses are expected to climb due to SB 863 PD increases, so overall claim severity is expected to rise 7% to $86K. Also, average ALAE/AY 2014 indemnity claim is projected to increase 10% over the AY 2013 level, but with DWP up, the ultimate AY 2014 loss and ALAE ratio is expected to fall to 79.4% of DWP, while the ultimate industrywide combined ratio is pegged at 105% of premium. Executive Briefing (9/2/15) (members only) Medical and Indemnity Benefit Trends, AY 2002-2014. Initial data on AY 2014 lost-time claims indicate that average medical payments at 3 and 6 months post injury declined following implementation of SB 863, though the 12- and 24-month data on claims from prior years still show average losses trending up, led by ongoing increases in payments for prescription drugs and DME. CWCI Research Update (8/25/15) (members only) Bulletin (8/25/15) (members only) News Release (8/25/15) (public) Executive Briefing (9/2/15) (members only) Medical Development: California vs. Other States. A recent WCIRB report finds that both treatment & claim duration are longer in Calif than other states. Reviewing workers’ comp medical data up to 30 years post-injury, WCIRB found similar treatment patterns across venues, though a smaller share of California claims closed within 3 years of injury, and thus a higher percentage of claims involving prolonged treatment for cases in which acute conditions evolved into chronic medical problems. Executive Briefing (7/23/15) (members only) California Workers’ Compensation Independent Medical Review: 1st Quarter 2015 Outcomes. An analysis of 2015 independent medical review (IMR) outcomes shows there was no significant reduction in IMR volume in the first quarter of this year, even though the independent medical reviewers continue to concur with the utilization review (UR) physician’s denial or modification of treatment in about 90 percent of the cases. CWCI Spotlight Report (7/7/15) (members only) Bulletin (7/7/15) (members only) News Release (7/7/15) (public) Executive Briefing (7/23/15) (members only)
Legal Contra Costa County v. WCAB (Dahl). To rebut a scheduled rating the injured worker must establish that the industrial injury rendered her incapable of rehabilitation. Significant Decision Summary (9/29/15) (members only) Matute v. Los Angeles Unified School District. The time to file an appeal to an IMR decision is extended by 5 days for mailing. Significant Decision Summary (9/24/15) (members only) Melendrez v. Ameron. The Court of Appeal upholds the exclusive remedy bar for an employee with substantial exposure to asbestos and discounts that the employee was a casual consumer of products containing asbestos. Significant Decision Summary (9/23/15) (members only) NSC Report Warns of Employer Liability for WC-Related Opioid Deaths. Citing 15 court cases from the past 7 years, a National Safety Council report finds that widespread opioid use in general, and more specifically among workers’ comp claimants, has raised the risk of injured workers becoming addicted to these drugs and suffering fatal overdoses. The NSC notes that in many circumstances courts have ruled that addiction and death arising from opioids prescribed to injured workers are compensable. Executive Briefing (7/23/15) (members only) The Employee v. Contractor Debate. The Labor Department issued a directive in July to clarify for employers and the courts when workers should be classified as employees rather than independent contractors. The key, according to the feds, is whether the worker is “economically dependent” on the employer. Executive Briefing (7/23/15) (members only) Angelotti Chiropractic v Baker, et al. The 9th District Court of Appeal ruling that the lien activation fee, Labor Code section 4903.06(a)(1), added by SB 863, is a constitutional exercise of the Legislature’s authority. The preliminary injunction precluding the DWC from collecting the lien activation fee was vacated. Significant Decision Summary (7/13/15) (members only)
Statutory/Regulatory ICD-10 Oct 1 Roll-Out. DWC posted the final regulations governing the California workers’ compensation system’s transition from the ICD-9 system of diagnosis to the ICD-10 system, which takes effect Oct 1. A CWCI spotlight report on the transition to the ICD-10s will be issued in late September. Executive Briefing (9/23/15) (members only) CURES Update. The 1/1/16 deadline for doctors and pharmacists who are authorized to prescribe, order, administer, furnish or dispense controlled substances to register for CURES access will extended by a bill (AB 679) that was gutted, amended and passed by legislators on the last day of the 2015 legislative session. AB 679 is now on the governor’s desk, and once he signs it, the mandatory enrollment deadline will be extended to 7/1/16. Though the bill requires doctors and pharmacists to register so that they can access CURES, it does not require them to check the system before writing a prescription or dispensing a controlled substance, though it may be a step in that direction. Executive Briefing (9/23/15) (members only) Electronic Submission of Medical Records. DWC is seeking input on the issue of electronic transmission of medical records and reports – including the idea of mandating electronic IMR applications to expedite medical dispute resolution. A meeting was slated for early September in Oakland to gather comments. Executive Briefing (9/2/15) (members only) QME & Benefit Notice Regs Are Done. Final regulations governing qualified medical evaluators and revisions to the benefit notices have been finalized by the state. Under the new QME regs, which took effect Sept. 1,panel requests for claims of represented injured workers must be submitted online through the DWC website. DWC will immediately issue a QME panel to the requesting party for service on all parties. The regs also include a new QME Form 105 for unrepresented workers. The benefit notice regs, which take effect 1/1/16 , require a number of changes to information that must be provided to workers before & after a work injury, including the general WC posting notice; WC benefit notice letters that are sent to injured workers at various points in the life of a claim; and the DWC-1 Claim Form/Notice of Potential Eligibility (NOPE). Executive Briefing (9/2/15) (members only) News Release (9/3/15) (public) Forms/Publications Listings (9/3/15) ( public) Transition to ICD-10. CWCI 1st 15-day comment on proposed regulations on the ICD-10 transition. 15-Day Comment (8/3/15) ( public) CURES 2.0 RollOut. The California Dept. of Justice announced that it plans to pilot test the updated version of the CURES pharmacy data management program and conduct a phased-in rollout starting in July with a select group of providers who use the current CURES system and who meet the required security standards and minimum browser specifications. Executive Briefing (7/23/15) (members only) Benefit Notice Regulations. The DWC submitted its proposed changes to the benefit notice regs to the Office of Administrative Law in mid-July. OAL has 30 days from submission to review them. If approved as drafted, the regs will be filed with the Sec’y of State and the long-awaited SB 863 updates to benefit notice letters, WC posting notices, new hire pamphlets and claim forms will take effect January 1, 2016. Executive Briefing (7/23/15) (members only) CWCI Web-Based Regulatory Training. CWCI’s online seminar on MTUS Revisions, the New Copy Service Fee Schedule and the regulations governing DIR’s $120 million per year Return to Work Supplement Program will be offered as an on-demand webinar for a limited time. Executive Memo (7/22/15) (members only) News Release (7/22/15) (public) Modifications to Workers’ Compensation Information System (WCIS) Regulations: CWCI comments on the proposed revisions to the Workers’ Compensation Information System regulations 1st Forum Comments (7/20/15) ( public) MTUS Guidelines on Chronic Pain Treatment and on Opioids Treatment, §§ 9792.24.2 & 9792.24.4: CWCI 45-day comment on proposed regs on Chronic Pain and Opioid Treatment Guidelines 45-Day Written Testimony (9/1/15) ( public) Transition to ICD-10. CWCI 45-day written testimony on proposed regulations on the ICD-10 transition. 45-Day Written Testimony (7/7/15) ( public) Benefit Notice, Posting Notice, Claim Form/NOPE. CWCI second 15-day comments on the proposed benefit notice regulation revisions. 2ndt 15-Day Comments (7/3/15) ( public) Qualified Medical Evaluator Regs. CWCI’s comments on proposed changes to the QME regs, 1st 15-day comment period. 1st 15-Day Comments (6/20/15) ( public)
Other No Amendment to 1/1/16 Rate Filing. At its 9/3/15 meeting, WCIRB’s Governing Committee reviewed insured loss data valued through June and decided to retain the Pure Premium Rate recommendation sent to the Dept of Insurance on 8/19/15, noting that in the 2Q modest improvements in medical loss development were again partially offset by slight deterioration in claim frequency, and that the continued wage growth forecast in the filing merit caution given recent turmoil in financial markets. At the 8/22/15 rate hearing, WCIRB proposed advisory pure premium rates averaging $2.45/$100 of payroll, 7.8% less than the corresponding industry average filed pure premium rate of $2.66 as of 7/1/15, and 0.8% less than the average approved July 1, 2015 advisory pure premium rate of $2.47. Executive Briefing (9/23/15) (members only) CWCI’s 52nd Annual Mtg… Save the Date: the 2016 meeting will be Thursday, 3/17/15 at the Oakland Marriott. Executive Briefing (9/23/15) (members only) Minutes of Claims & Medical Care Committee Meeting Meeting Minutes (9/15/15) (members only) Minutes of Legal Committee Meeting Meeting Minutes (8/6/15) (members only) CWCI Announces Move to New Office. The Institute will relocate to a newly remodeled suite of offices at 1333 Broadway, Suite 510, Oakland 94612 in late August. The new location is directly upstairs from the 12th Street/Oakland City Center BART station. Phone numbers, emails and the Institute’s web address will remain the same. Executive Memo (7/22/15) (members only) News Release (7/22/15) (public) CWCI Hotlinks Update for 2Q 2015. Listings of all CWCI publications produced during the second quarter of 2015, 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. Hotlinks (7/1/15) (members only) |