Q1, 2018 – March 28, 2018
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Research Interactive App Gives CWCI Members Access to Claims Data by Industry, Region and AY. CWCI members can access detailed industrywide data via the regional scorecard interactive application that they can use to examine claims experience for specific industries, regions, accident years and for all claims or just indemnity claims Executive Briefing (3/29/18) (members only) Independent Medical Review Decisions, January 2014 Through December 2017. An updated look at IMR volume and outcomes through the end of 2017, including comparative analyses from prior years based on a review of 648,450 IMR decision letters issued from 2014 through 2017. Research Update Report (3/14/18) (members only) Bulletin (3/14/18) (members only) News Release (3/14/18) (public) Executive Briefing (3/29/18) (members only) California Workers’ Compensation Prescription Drug Distributions & Opioid Trends. A CWCI study that uses data from 12.5 million prescriptions dispensed to California injured workers from 2007 to June 2017 to measure changes in the prescription and payment distributions among major therapeutic drug groups used in California workers’ comp indemnity claims and to take an in-depth look at the trends in the volume, cost, potency and types of opioids used. The opioid data includes the changing percentage of indemnity claims involving opioids at different stages of claim development, the average number of opioid prescriptions per opioid user and per opioid prescription at different levels of claim development across accident years; total MMEs per opioid user and per opioid prescription at the different levels of claim development across accident years; the prescription and payment distributions for brand and generic opioids for 2008 to 2017 fill dates; and the changes in the prescription and payment distributions for common opioids (based on drug ingredient) over the past decade. Research Update Report (3/13/18) (members only) Bulletin (3/13/18) (members only) News Release (3/13/18) (public) Revisiting 24-Hour Health Care Coverage and Its Integration With the California Workers’ Compensation System.” A white paper that discusses the issues, opportunities, and unresolved problems surrounding the potential integration of workers’ compensation into a 24-hour system. To put the current health care system integration efforts into context, the paper also takes a historical look at proposed or enacted workers’ compensation and health care reforms – including legislation promoting 24-hour coverage or managed care principles – since the Clinton Administration’s efforts to adopt 24-hour coverage in the early 1990s. Spotlight Report (3/2/18) (Public) Executive Memo (3/2/18) (members only) News Release (3/2/18) (public) Changes in the QME Population and Medical-Legal Trends in California Workers’ Compensation. A CWCI study that tracks changes in the composition of the Qualified Medical Evaluator (QME) population in California workers’ compensation in terms of medical specialty representation and geographic availability, comparing data on medical providers certified as QMEs in 2012 and in 2017. The study also uses 2007 – June 2017 claims data to examine changes in the level of services rendered by evaluators, the mix of services, average payments for all medical-legal services and for specific levels of service, and the proportion of evaluations performed by AMEs vs. QMEs. Research Update Report (2/28/18) (public) Bulletin (2/28/18) (members only) News Release (2/28/18) (public) Workplace Fatality Data. DIR data show that 376 Californians died on the job in 2016, down slightly from the 388 deaths in 2015 – though the 2015 numbers were skewed by a single incident: the December 2015 terrorist attack on the Inland Regional Center in San Bernardino in which 14 workers lost their lives. The new numbers come from the Census of Fatal Occupational Injuries, which is conducted annually in conjunction with the U.S. Bureau of Labor Statistics. For the past decade, California’s workplace fatality rate has held steady at about 2.2 deaths per 100K workers — below the pre-recession (pre-‘08) level and below national workplace fatality rate, which jumped from 3.4 to 3.6 per 100K workers between 2015 and 2016. Executive Briefing (2/12/18) (members only)
Statutory/Regulatory Hearing Reveals Delays in Requiring Doctors to Check CURES. The State Senate’s Business & Professions Committee held a hearing in February on the use of the CURES drug monitoring program to fight the abuse of opioids & controlled substances. AB 482, signed in Sept 2016, required physicians to check CURES before initially prescribing a controlled substance and every 4 months thereafter for as long as they continue to renew the prescription. But that requirement has yet to be implemented because it can’t take effect until 6 months after the state Atty General certifies that CURES is ready for statewide use and that the Department of Justice has staff to run the program, neither of which has yet to occur. Executive Briefing (2/12/18) (members only) Employer Reminder: Time to Post the OSHA 300A Form. Insurers may want to remind their policyholders that if they haven’t already done so, they need to complete and post their Form 300A summary of job-related injuries and illnesses from 2017, which should remain posted in a common area at their place of business from Feb 1 – April 30. Executive Briefing (8/10/17) (members only) Impact of State and Local Minimum Wage Laws on AWW and TTD Payments. A reminder to claims organizations that a scheduled wage increase that becomes effective during the period of temporary disability is relevant to the issue of earnings at the time of injury. Although this typically applies to collective bargaining agreements with locked-in wage increases, a wage increase that can be “reasonably anticipated” at the date of injury applies to the benefit of the injured worker to the extent that it affects earning capacity. California’s minimum wage increased as of 1/1/18, with several municipalities also increasing their minimum wage beyond the state’s minimum, so it should be noted that a change in state law — or that of a city or municipality — that increases the minimum wage would likely apply here, requiring an adjustment to the Average Weekly Wage (AWW) and TD rates for those workers whose earnings are at or near minimum. Executive Memo (1/10/18) (members only)
Legal Recent Court Actions on Workers’ Comp Issues. State lawmakers proposed only a handful of workers’ comp bills in February and March of 2018, but the the courts were busy dealing with several workers’ comp issues. Executive Briefing (3/29/18) (members only) County of San Diego v. WCAB (Pike). The Court of Appeal reversed the WCAB and held that L.C. section 4656(c)(2) prohibits TD awards for periods after five years from a post-1/1/2008 DOI, even where the case has been timely reopened and the TD started within 5 years from DOI. The plain language of the statute states that payments cannot be ordered past five years from DOI. CWCI filed an amicus brief at the Court of Appeal in support of the defendants. Significant Decision Summary (3/6/18) (members only) Federal Court Rules on Classification of Gig Workers. In a groundbreaking decision with potentially far-reaching implications for “gig economy” employers such as Uber and Lyft, a federal judge in San Francisco issued a ruling on Feb. 8 in favor of a food delivery service, agreeing that the drivers it uses are independent contractors and not employees, and as such, are not entitled to employee protections afforded by California law. Executive Briefing (2/12/18) (members only) SCIF v. WCAB (Guzman) In a published opinion, the Court of Appeal ruled in favor of the defense where the injured worker had less than six months of employment but claimed entitlement to compensation for a psychiatric injury based on a “sudden and extraordinary employment condition” exception under L.C. section 3208.3(d). The only evidence presented was applicant’s subjective testimony that he was surprised at the accident. The court remanded to the WCAB with directions to deny the claim for psychiatric injury. CWCI acted as amicus in the case, and helped to obtain publication of the court’s decision. Significant Decision Summary (2/23/18) (members only) CWCI’s 20th Annual Case Law Seminar. The Institute has scheduled its annual California Workers’ Compensation Case Law Update Seminar for May 14 in San Francisco and May 16 in Long Beach. Executive Briefing (2/12/18) (members only) Executive Memo (2/27/18) (members only) News Release (2/27/18) (public) Seminar Flyer (2/27/2018) (public) Executive Briefing (3/29/18) (members only) DCA Rejects Constitutional Challenge to IMR Physician Confidentiality. On Jan. 12 the 1st DCA affirmed a WCAB ruling in Zuniga v. WCAB (Interactive Trucking), holding that injured workers do not have a right to know the identity of the IMR physician who reviewed their medical treatment request. CWCI had filed an amicus brief in support of the defense position in the case, which had been pending before the 1st DCA since Oct 2014. Executive Briefing (2/12/18) (members only) Zuniga v. WCAB. In a published opinion, the Court of Appeal held that applicant’s due process rights are not violated by the anonymity provisions of IMR review in L.C. section 4610.6(f), and that permitting cross-examination for the purpose of uncovering additional grounds to challenge a determination would undermine the Legislature’s intent to reduce litigation, costs, and delays. CWCI requested and obtained an order of publication in this case, rendering it as binding authority. Significant Decision Summary (1/26/18) (members only)
Other Minutes from the Claims/Medical Care Committee Meeting. The meeting was held March 14 at the TransPacific Center in Oakland. The agenda included presentations of recent CWCI research on IMR outcomes, prescription drugs, and changes in the QME population; a review of legal challenges to the workers’ comp reforms; an update on recent regulatory activity including the adoption of the MTUS drug formulary and the provider suspension regs, the draft regs on mental illness and stress, benefit notices, and home health care; and expected regulatory action on UR, the interpreter fee schedule and traumatic brain injury treatment guidelines. Additional discussions covered the copy service fee schedule and opioid prescription transition reports due from physicians in April. Meeting Minutes (3/16/18) (members only) CWCI Elects 2018 Board of Directors. The Institute elected its 2018 Board of Directors at the 54th Annual Meeting in Oakland. Rose Barrett of the Berkshire Hathaway Companies was elected to chair the Board. News Release (3/16/18) (public) Minutes from the Legal Committee Meeting. The meeting was held Thursday, February 1 by conference call. The agenda included status reports on CWCI amicus activity ( Zuniga; King; Pike, Guzman, Black v. Corvel)); updates on the status of 2 cases (Duncan and Timons): a report on Chamber of Commerce activity by Saul Allweiss; and an update on regulations (drug formulary; MTUS updates, and the RTW Supplement Fund Stakeholder meeting); and an update on the litigation environment. Meeting Minutes (2/1/18) (members only) CWCI Hotlinks Update. 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. Hotlinks Q4/17 (3/18/17) (members only) |