Communications / Quarterly Summaries / Quarterly Summary

Q1 – 2025 – March 31, 2025

Research

CWCI’s Summary of the NASI Report on CY 2022 WC Benefits, Coverage and Costs. CWCI analyzes the CY 2022 data on workers’ compensation benefits, coverage and costs compiled by the National Academy of Social Insurance, examining nationwide results and comparing them to those from California. The latest results show that California represents 1 out of every 8 covered employees in the U.S.; 1 out of every 7 covered payroll dollars; and more than 1 out of every 5 workers’ compensation benefit payments.

Bulletin (3/26/25) (members only)

Use of Anti-Diabetic Drugs for Weight Loss in Calif WC. Obesity is a common comorbidity among injured workers, and Antidiabetic drugs are sometimes prescribed in WC if obesity is deemed a contributing factor to a work injury or if weight loss is considered necessary for the worker’s treatment and recovery. Heavily marketed brand-name Antidiabetics include Semaglutide (Ozempic, Rybelsus, Wegovy), empagliflozin (Jardiance), and dulaglutide (Trulicity), and CWCI’s Rx Drug Data App finds that use of these high-cost drugs is up sharply in recent years. Semaglutide began to appear in CWCI’s Rx data in 2022, when it represented only 3.3% of all Antidiabetic meds prescribed to injured workers, but the avg payment was $1,057, so it accounted for 8.3% of the total Antidiabetic drug spend. By the first half of 2024, semaglutide’s share of the Antidiabetic prescriptions nearly doubled to 6.4%, and w/an avg payment of $1,069 its share of the Antidiabetic drug spend jumped to 16.7%. Empagliflozin first appeared in CWCI’s prescription drug data in 2020, when it represented 2.8% of the Antidiabetic drug prescriptions, and w/an avg payment of $832/prescription, it accounted for 5.7% of the payments in its drug group. By the first half of 2024 empagliflozin’s share of the Antidiabetic prescriptions doubled to 5.6% and w/an avg payment of $889, its share of the Antidiabetic drug spend more than doubled to 12.3%. Dulaglutide first registered in CWCI’s drug data in 2019 when it represented just 2.0% of Antidiabetic prescriptions, but at $813/prescription it consumed 4.1% of the Antidiabetic drug spend. In 2022, Eli Lilly announced a shortage of the drug due to a surge in demand after prescribers began seeking alternatives to Ozempic as supplies of that drug began to dry up after the FDA approved it for weight loss. At that point, dulaglutide accounted for 4.6% of Calif WC Antidiabetic prescriptions and 11.3% of the payments in its drug group. In 2023, it increased to 6.0% of the Antidiabetic prescriptions, and at $931/prescription, 11.4% of the Antidiabetic drug spend. The dulaglutide shortage continued into 2024 and 2025, and physicians may have opted for alternatives as initial data from early 2024 show no dulaglutide prescriptions or payments in CWCI’s Rx drug data. While there may be cases where use of these drugs is warranted in WC, not all of them are FDA-approved for weight loss (though they may be prescribed off-label for such) so claims organizations should review requests for these drugs carefully, especially considering the side effects, the need for long-term monitoring and lifestyle changes to maintain the weight loss, the cost of the meds, and the availability of alternative treatments.

Executive Briefing (3/21/25) (members only)

Claim Characteristics and Trends Interactive Application. CWCI’s systemwide app with data on all insured and self-insured workers’ compensation claims reported to the DWC’s Workers’ Compensation Information System (WCIS). Featuring data from AY 2018 forward, the app shows overall trends and claim distributions by region, industry, and injury characteristics and allows users to track the number of reported and projected claims by year, by quarter and year, or by month and year. Filters can be used to view results for combinations of insured and self-insured claims, by claim type, industry, region, injury description, reporting timeliness, and COVID-19 status.

Interactive Data Application (2/27/25) (public)

Cost-Driver Medications: The $1,000 Drug Club. One feature of CWCI’s Prescription Drug Interactive Application allows users to identify the average amount paid for drugs dispensed to Calif injured workers in a given calendar year. The latest update to the app shows the average amounts paid for prescriptions filled during each of the 14-1/2 years spanning 2010 through June 2024. The app includes the % of prescriptions, % of payments, average payments, and % brand for all drugs that had 30 or more prescriptions dispensed in a calendar year. A breakdown of that data by drug ingredient reveals a dozen drugs with average payments of at least $1,000. Several of the $1,000+ drugs should sound familiar. Four are heavily marketed Migraine Drugs (Nurtec, Ubrelvy, Ajovy, and Qulipta) highlighted in our October 2024 Spotlight report, while physician-administered Hylan is an injectable viscosupplement noted in our July 2023 study on low-volume/high-cost Musculoskeletal Drugs. Diclofenac Sodium–Lidocaine HCL (Diclona), dispensed as a gel, a patch, or in a “tape kit,” is one of the private-label topicals linked to the emergence of dermatologicals as the costliest drug group in California workers’ compensation in the first half of 2024 (CWCI Bulletin 25-02). Among the other drugs that had an average reimbursement of $1,000+ in the first half of 2024 are:

Somatropin (Humatrope, Norditropin, or Zomacton), a human growth hormone that had the highest average reimbursement ($1,926);
Brexpiprazole (Rexulti), another heavily marketed brand drug used to treat major depressive disorder and schizophrenia;
OnabotulinumtoxinA (Botox), an injectable neuromuscular drug sometimes used to prevent headaches, muscle stiffness in the elbow, wrist and fingers, and incontinence;
Dextromethorphan HBr Quinidine Sulfate (Nuedexta), a psychotherapeutic/neurological drug used to treat Pseudobulbar Affect, which causes involuntary, sudden and frequent episodes of crying and or laughing in people living with certain neurologic conditions or brain injuries;
Semaglutide (Ozempic), the weight loss drug used to treat obesity and diabetes; and
Raltegravir Potassium (Isentress), one of the brand-name antiviral drugs used as part of the drug “cocktail” used to treat HIV as well as for occupational postexposure HIV prophylaxis.

Bulletin (1/9/25) (members only)

Executive Memo (1/31/25) (members only)

Insured Experience Through Q3 2024. DWP and average charged rates for the first 9 months of 2024 were both about 1% higher than they were in the first 9 months of 2023 the WCIRB said in its Q3 2024 experience report. Written premium through the end of Sept was $12.3 billion vs, $12.1 billion for the same period in 2023. WCIRB also said DWP increased to $15.9 billion in 2023 from $15.7 billion in 2022, as payroll growth more than offset continued rate reductions, which have decreased every year since 2015. The Bureau did note, however, that avg charged rates per 100 of covered payroll were $1.61 for the 9 months ending in September 2023 vs. $1.60 in AY 2022, suggesting that the rate decreases may be stabilizing after declining by 50% from $3.19 in 2014. WCIRB estimates the AY 2023 combined loss/expense ratio will increase from 110% of DWP in 2022 to 113% in 2023. While that is still below the 10-year high of 115% estimated for 2021, it’s 35 points higher than the 10-year low of 78% in 2016. The Bureau ascribes the increase in the 2023 combined ratio to an increase in avg claim severity as the projected medical severity per 2023 indemnity claim climbed to $33,615 (+2% from 2022 and +25% from 2016), reflecting medical fee schedule changes and lower claim settlement rates, while on the indemnity side, avg indemnity per 2023 claim is projected at $29,810, up 1% from 2022, but up 26% since 2016 due to higher wages since the onset of the pandemic. Also contributing to the increase in the combined ratio: the projected ultimate allocated loss adjustment expenses (not including medical cost containment) on AY 2023 claims jumped 13% from $10,575 in 2022 to $11,917 due to a slower settlement rate and higher post-pandemic defense costs, while avg medical cost containment expense, which had been trending down since 2019, are projected to increase 5% to $2,300 per 2023 indemnity claim. Thus, WCIRB projects the ultimate total loss per AY 2023 indemnity claim will rise to $77,642, up 3.2% from AY 2022 and up 25.4% from the 2016 low.

Executive Briefing (1/23/25) (members only)

California Workers’ Compensation Inpatient Hospital Utilization, CY 2012 through CY 2023. A review of data from the latest update to CWCI’s Inpatient Hospital Utilization Application which now includes inpatient hospital discharge data for CY 2012 through CY 2023 compiled by the California Department of Health Care Access and Information (HCAI). The report provides a refresher on how the application is formatted and can be used, and highlights some of the latest results and trends, including data that can be used to track and compare changes in the volume of inpatient hospitalizations paid under California workers’ compensation, Medicare, Medi-Cal, and private coverage since 2012.

Executive Memo (1/16/25) (members only)

Interactive Research Report (1/16/25) (members only)

Interactive Data Application (1/16/25) (public)

Public Self-Insured Losses Up in FY 2023/24 1^st Report. CWCI’s analysis of Calif public self-insured 1st report claims data compiled by the state Office of Self-Insurance Plans found that after declining in FY 2022/23 due to a sharp drop in COVID claims among public safety and government workers, total paid losses for Calif public self-insured entities increased by nearly $42.6 million (8.3%) to $552.9 million last year as avg medical payments rose 18.3% and avg indemnity payments rose 5.3%. The increase in aggregate payments came despite a 1.8% decline in the number of reported claims, which pushed public self-insured claim frequency back down to a pre-pandemic level. At the same time, public self-insured total incurred losses in the first reports jumped nearly $150 million to a record $1.69 billion as avg incurred medical rose 14.8% and avg incurred indemnity jumped 9.4%.

Executive Briefing (1/23/25) (members only)

Bulletin (1/14/25) (members only)

News Release (1/14/25) (public)

Dermatologicals Are Now the Costliest Drug Group in California Workers Comp. New CWCI data shows recent shifts in the types of drugs prescribed to injured workers in California, and in the distribution of payments for those medications, with anti-inflammatory drugs ranking first in terms of the number of prescriptions, but dermatologicals, which include a number of high-priced, private label drugs, accounting for the biggest share of the total drug spend. The latest data from CWCI’s Rx Drug App ranks the top 10 therapeutic drug groups in California workers’ comp based on the volume of prescriptions and total reimbursements. Comparing the distributions of drugs dispensed to injured workers from 2016 through June 2024, CWCI analysts noted the shifts in prescription drug utilization and reimbursement among the drug groups suggested an association between the ongoing decline in opioid use with the state’s adoption of the Opioid and Pain Management Guidelines into the Medical Treatment Utilization Schedule (MTUS) in late 2017, and the implementation of the MTUS Formulary in 2018. The historical data show that anti-inflammatories such as ibuprofen and naproxen, often used as non-narcotic alternatives to treat pain, surpassed opioids to become the top drug group in 2016, and by 2021 they accounted for a record 35.3% of all prescriptions dispensed to California injured workers. Looking at the mix of prescriptions by drug ingredient shows that most of the growth in anti-inflammatories was due to increased use of inexpensive ibuprofen, which increased from 32.9% of all anti-inflammatories in 2017 to 42.2% in 2021, at which point it stabilized. Ibuprofen remains the most heavily used drug in California workers’ compensation, representing 14.1% of all prescriptions in 2023 and 13.7% in the first half of 2024, ranking well ahead of naproxen, which ranks second with 8.2% of the 2023 prescriptions and 7.9% of the prescriptions from the first half of 2024. At the same time, opioids’ share of workers’ comp prescriptions fell to 7.9% in 2023 and 7.6% in the first six months of last year, about a third of its 22% share in 2016 and about a quarter of its record 30.8% share in 2010.

News Release (1/9/25) (public)

CWCI Develops New California Workers’ Comp Interactive Data App. CWCI launched a new, systemwide, online application with data on all insured and self-insured California workers’ compensation claims from accident years 2018–2024 reported to the state’s Workers’ Compensation Information System (WCIS). The Institute designed the new application, the Claim Characteristics and Trends App, by modifying its COVID-19/Non-COVID-19 reporting tool, introduced in the summer of 2020, to make it more reflective of all California workers’ compensation claims in the post-pandemic era. The app, featuring two data tabs and a reference tab detailing the data and methods used to construct the application, focuses on overall trends and claim distributions by region, industry, and injury characteristics, and allows users to access data on the number of reported and projected claims by year, by quarter and year, or by month and year. Filters within each of the data tabs can be used to build customized views showing results for combinations of insured and self-insured claims, as well as by claim type, industry, region, injury description, reporting timeliness, and COVID-19 status. The app also tracks the number and rate of California workers’ compensation death claims. To keep the information current, CWCI plans to update the app on a monthly basis as new WCIS data becomes available.CWCI’s Claim Characteristic and Trends App was made possible through special access to the California Division of Workers’ Compensation’s WCIS data and is available to the public. It can be found under the Research tab on the Institute’s home page (www.cwci.org).

News Release (1/8/25) (public)

Interactive Data Application (1/8/25) (public)

Statutory/Regulatory

Hearing Set for WC Bills. The Senate Committee on Labor, Public Employment and Retirement scheduled a hearing for March 26 to hear testimony on 4 WC bills:

SB 8(Ashby) would add Sacramento County park rangers to the list of first responders entitled to 4850 salary continuation benefits in lieu of TD.
SB 20(Menjivar) would protect workers in stonecutting shops from exposure to respirable crystalline silica by requiring the shops to use wet methods to cut stone slab products for countertops and other projects. SB 20 would authorize Cal/OSHA to issue immediate stop-work orders to companies cutting stone slabs using dry methods and direct DPH to adopt a trainingcurriculum for safe fabrication and to implement a process to certify that owners and operators of fabrication shops are enrolled in or have completed the training as of July 2027. The bill would allow DPH and Cal/OSHA to track violations issued to shops for failure to meet standards relating to respirable crystalline silica and track the number of new silicosis cases in any shop and the notices issued to shops for noncompliance with respirable crystalline silica regs.
SB 230(Laird) would expand the cancer presumption in LC §3212.1 to firefighters at commercial airports regulated by the FAA. The presumption already covers police and firefighters, as well as firefighters at Dept of Defense installations and NASA facilities. The bill would also extend the LC §3212.15 PTSD presumption that currently applies to Defense Dept and NASA firefighters to firefighters at airports regulated by the FAA, and in some cases, would add firefighters at other federal locations to the presumptions in LC §§3212 (hernia, heart trouble and pneumonia), 3212.15, 3212.6 (tuberculosis), 3212.8 (bloodborne illness and MRSA), 3212.85 (biological and chemical agents) and 3212.9 (meningitis).
SB 447 (Umberg) would enhance first responder death benefits by extending the time that employers must provide health benefits for minor dependents by 5 years. When first responders die from an injury caused by external violence or physical force while performing their job, their employers must continue to provide health benefits to their spouse unless the spouse elects to receive a lump-sum survivor’s benefit. Minor dependents continue to receive benefits under the coverage provided to the spouse. If there is no surviving spouse, minor dependents now receive health coverage until age 21 but SB 447 would extend that coverage to age 26.

Executive Briefing (3/21/25) (members only)

Labor Bill Would Limit Use of AI in the Workplace. An AFL-CIO backed bill (SB 7, McNerney), dubbed the “No Robo Bosses Act,” would require employers or their vendors to maintain a list of all Automated Data Systems (i.e., AI) that they use and to notify employees who may be directly or indirectly subject to employment decisions generated by the systems. The bill would:

prohibit use of AI to discharge, threaten to discharge, demote, suspend, or discriminate or retaliate against a worker for taking certain actions asserting their rights under the bill
require employers to give workers access to data collected or used by AI so they can correct errors in data in specified areas
require employers and their vendors to notify workers affected by an AI-generated employment decision and provide them w/a form to appeal w/in 30 days of notification
require employers or vendors to respond to appeals w/in 14 business days, assign a human reviewer to evaluate all evidence, and rectify the decision w/in 21 business days if the reviewer decides that the decision should be overturned
require the Labor Commissioner to enforce provisions of the bill and authorize a prosecutor or any worker who has suffered a violation or their representative to bring a civil action
set forth specified types of relief that a plaintiff may seek and that an employer that violates these provisions is subject to (including civil penalties of $500 per violation)

SB 7 would also reportedly ban AI systems from using personal data to predict a worker’s future behavior. Author’s amendments were added after which SB 7 was sent back to the Rules Comtee.

Executive Briefing (3/21/25) (members only)

Posting Notices and New Hire Notices Updated… In 2024, Gov. Newsom signed AB 1870, which amended LC §3550 to require the addition of information on an employee’s right to consult an attorney to the DWC 7 posting notice. DWC has revised the DWC 7 and posted a downloadable version online. AB 1870 took effect 1/1/25, so insurers and employers should make sure the updated version has been filled out and posted. LC §3551 requires employers to give every new employee, either at the time of hire or by the end of the first pay period, written notice of the information in LC §3550, so CWCI added the information on attorney consultations to our Facts About Workers’ Comp new hire notice to make it comply w/the statutory requirements. DWC approved CWCI’s revised notice in February and the Institute had it translated and printed, so it is available in English and Spanish, as required by law. An Exec Memo was sent to our designated claims contacts to alert them of the change. The updated Facts About Workers’ Compensation Notice to New Employees, the 5-part DWC-1 Claim Form and NOPE, and CWCI’s Facts For Injured Workers pamphlet (which is not mandatory, but is often used early in the life of a claim to remind injured workers of their rights and obligations) are all available in sets of 100 at www.cwci.org/store.html. CWCI members are eligible for a 15% discount.

Executive Briefing (3/21/25) (members only)

Executive Memo (3/18/25) (members only)

Bulletin (3/18/25) (members only)

News Release (3/18/25) (public)

CWCI Comments on Proposed Modifications to the Utilization Review Regulations. CWCI’s 15-day public comments on the DWC’s proposed changes to the text of rules related to the UR regulations.

15-Day Public Comments (3/16/25) (members only)

CWCI Comments on Proposed Modifications to MPN Regulations. CWCI’s 2^nd Forum Comments on proposed modifications to the text of rules related to the Medical Provider Network Regulations.

2nd Forum Comments (3/5/25) (members only)

FDA Approves Suzetrigine, a First in Class Nonopioid Pain Med. In late January the FDA approved a first-in-class nonopioid analgesic to treat all types of moderate-to-severe acute pain in adults. Suzetrigine (Journavx) 50 mg oral tablets work by targeting sodium channels in the peripheral nervous system so that pain signals from the periphery are blocked at the spinal cord level before they reach the brain. Journavx’s efficacy was evaluated in two randomized, double-blind, placebo- and active-controlled trials of acute surgical pain, one following abdominoplasty and the other following bunionectomy. In addition to receiving the randomized treatment, all participants in the trials with inadequate pain control were permitted to use ibuprofen as needed for “rescue” pain medication. Both trials resulted in statistically significant superior pain reduction w/Journavx compared to placebo. The most common adverse reactions were itching, muscle spasms, increased blood level of creatine phosphokinase and rash. Journavx, was only approved for the treatment of acute pain (2 weeks or less), but the manufacturer is studying whether it can help manage long-term neuropathic and spinal pain, which could open the door to use for long-term chronic pain. Priced at $15.50/pill and taken twice a day, the cost is higher than generic opioids commonly used for acute pain, but it comes w/o the long-term risk of addiction, so it is touted as safer and potentially less expensive for acute pain patients, though if approved for chronic pain, it could have a significant impact on WC pharmaceutical costs.

Executive Briefing (2/26/25) (members only)

Most COVID-19 Nonemergency Standards End. DIR announced that most non-emergency standards it adopted 2 years ago to prevent COVID expired February 3, the only exceptions being the reporting and recordkeeping requirements [Title 8, Subsection 3205(j)] that remain in effect for another year. Though there is no longer a specific set of regulatory requirements relating to COVID-19 prevention, employers must still keep workers safe; identify, evaluate and correct unsafe or unhealthy conditions if they determine that COVID is a workplace hazard; keep a record of all COVID cases, including the location where the person worked, the date the person was last in the workplace and the date of a positive test or diagnosis; and provide information on COVID cases to the local health dept, CDPH, Cal/OSHA, and NIOSH immediately upon request and when required by law. More info is available on Cal/OSHA’s webpage under Archived COVID-19 Guidance and Resources. Employers with questions on requirements may contact Cal/OSHA consultation services at 800-963-9624.

Executive Briefing (2/26/25) (members only)

Cannabis and Pain Mgt Guidelines. DWC announced plans to incorporate ACOEM’s recently adopted Cannabis Guideline into the MTUS. The guideline does not recommend cannabis for pain mgt (including chronic, acute, or post-op pain) or for “safety-critical” workers (e.g., workers who operate vehicles or cranes, use knives at work, or who are at risk of falling from heights). According to the guideline, published Jan. 28, multiple trials show cannabis is only slightly better than placebos in managing neuropathic pain and that systematic reviews and meta-analysis found no meaningful evidence that it improved acute or post-op pain. The guideline noted adverse effects of cannabis — including slips, trips, falls, and other work injuries are “common” and that cannabis use is associated with unemployment, aggression, domestic violence, and criminal activity. DWC also plans to incorporate ACOEM’s revised Chronic Pain Treatment Guidelines, which were originally added to the MTUS in 2017, w/ACOEM’s updated guidelines published Dec. 19. DWC announced a virtual public hearing for March 14 to gather public testimony.

Executive Briefing (2/26/25) (members only)

DWC Proposes Update to MPN and Medical Billing Regs. DWC announced it was compiling public comments on a proposed update to MPN regs (CCR §9767.1 – 9767.19) in order to streamline the MPN review process and provide transparency by removing passcodes and requiring documentation of additional information to providers. The update also provides clarity on telehealth and remote service as well as access standards. The Division also announced a proposal to add CCR§ 9792.16 to the Rules for Medical Treatment Billing and Payment on or after October 15, 2011 to clarify contracting parties and contracting terms. Public comments on the draft proposals were accepted through March 5, 2025.

Executive Briefing (2/26/25) (members only)

Cal/OSHA Penalties Increase. In January, Fed-OSHA announced it was increasing its penalties, effective 1/15/25, to account for inflation. On 1/27/25, the Calif Dept of Industrial Relations followed suit, announcing increases in maximum civil penalties for Cal/OSHA violations classified as regulatory, general, willful, or repeat.

The maximum penalty for general & regulatory (including posting and recordkeeping) violations is $16,285.
The maximum penalty for willful and repeat violations is $162,851.
The minimum penalty for willful violations is $11,632.

State law authorizes Cal/OSHA to increase these penalties to make them consistent with federal OSHA’s civil penalties. The increases, which took effect on 1/1/25, are based on BLS’ October CPI for All Urban Consumers, which was up about 2.6% from a year earlier. The maximum penalty for violations classified as serious remains $25K.

Executive Briefing (2/26/25) (members only)

Legislative Update. Mid-February was the deadline for the introduction of bills for this year’s session. It’s expected to be a quiet year on the WC front, but a few bills of interest were introduced, including several that are rehashed versions of bills that failed in earlier sessions. Notable bills include:

AB 1125(Nguyen) would add security workers at state hospitals to the LC 3212.2 heart trouble presumption, which currently covers officers and employees at the Dept of Corrections, the now-disbanded Dept of Youth Authority and security officers at Atascadero State Hospital. The bill would remove the obsolete reference to the Youth Authority Dept and establish that any peace officer employed by the Dept of State Hospitals is eligible for the presumption. It is similar to SB 416, a 2019 bill that never got to final vote in 2020.
AB 1336(Addis) a rerun of SB 1299, which Gov. Newsom vetoed last year, AB 1336 would create a presumption of compensability for farmworker heat injury or illness claims if the WCAB determines their employer violated Cal/OSHA’s outdoor heat standards.
AB 1398(Valencia) would revise the LC §139.32 requirement that interested parties disclose financial interests in any entity to which they make referrals by requiring the parties to disclose their financial interests “to a 3rd-party payer or other entity to whom a claim for payment is presented for services furnished pursuant to a referral.”
AB 1498(Soria) would require the DWC to create an MPN for workers in the San Joaquin Valley (Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus and Tulare Counties) and make it operational by 2027.
SB 536(Archuleta) would expand fraud reporting requirements for WC insurers and the WCIRB (which currently report fraud to local DA’s and the CDI) by requiring them to report premium fraud to EDD. The bill would also require that EDD, upon written request, provide detailed payroll info, including payroll summary totals, so insurers, agents or a licensed rating organization could compare those records with WC claim and policy info from employers.
SB 555(Caballero) would require increasing the range of wages used to calculate PPD each year by an amount equal to the COLA for Social Security benefits. LC §4453 sets upper and lower bounds on the amount of weekly earnings used to calculate benefit amounts. Currently, benefits for workers earning less than $240 a week are calculated as though the workers are earning $240 per week. Earnings in excess of $435 per week are ignored when calculating PPD.
SB 632(Arreguin) would create a presumption that infectious diseases, cancer, musculoskeletal injuries, PTSD and COVID are compensable for employees providing direct patient care in an acute care hospital. SB 632 is nearly identical to SB 213, which was introduced in 2021 and carried over to 2022 but died in the Assembly Ins Comtee, and 2023’s AB 1156. In 2014, the Legislature passed a similar bill, AB 2616, but Gov. Brown vetoed it, noting that compensability of work injuries should be decided by the specific facts of each employee’s situation.

SB 668 (Hurtado) would require the DWC to update the Med Legal Fee Schedule (MLFS) any time it updates any section of the Official Medical Fee Schedule (OMFS) and at least every 2 years. To comply with LC §5307.1, DWC regularly updates the OMFS on a quarterly basis. The bill specifies that the DWC “may adjust the MLFS every 2 years based on an evaluation of medical practice costs, including consideration of increases in the conversion factor and the per-page cost of reviewing records as informed by the most current Medicare Economic Index.”

Executive Briefing (2/26/25) (members only)

New Calif WC Rx Drug Reimbursement Rules Coming. In December 2024 DWC adopted rules that incorporate Medi-Cal’s pharmaceutical reimbursement methodologies. The rules, which take effect July 1, eliminate the use of a drug’s average wholesale price (AWP) as a benchmark for reimbursement, and instead will set payments based on the lowest of the national average drug acquisition cost, the wholesale acquisition cost, the federal upper limit set by Medicaid, or the maximum allowable ingredient cost. The rules also increase the dispensing fee for physicians from $7.25 to $10.05, while pharmacies processing 90,000 or more claims a year will also receive a $10.05 dispensing fee and those processing 90,000 or fewer claims a year will be paid a $13.20 dispensing fee. The July 1, 2025 effective date gives billers and payers 6 months to update their systems, and according to a DWC Newsline, “There are sample pharmaceutical fee data files and (national provider identifier) files posted with the rulemaking materials which stakeholders may utilize in programming internal systems.” The Division also plans to post an updated pharmaceutical fee calculator by the July 1 effective date.

Executive Briefing (1/23/25) (members only)

DWC Floats SJDB Regulatory Changes. Last month the DWC posted a forum containing draft revisions to the Supplemental Job Displacement Benefits regs. The revised regs, drafted following indictments of several prominent vocational counselors and vocational school owners last year, propose to tighten requirements for vocational and RTW counselors and specify what educational program providers can be used. On Dec. 16, various stakeholders submitted comments on the regs to the forum. The draft regs are not yet at the formal rulemaking stage but can be seen here.

Executive Briefing (1/23/25) (members only)

Inflation-Adjusted Fed OSHA Penalties. In January the U.S. Dept of Labor adopted a final ruling, effective 1/15/25, that increased Fed OSHA penalties to account for inflation, as allowed under the Federal Penalties Inflation Adjustment Act Improvements Act of 2015. The final ruling made the following changes to the maximum penalties that can be levied against employers:$165,514, up from $161,323, for willful and repeated violations

$165,514, up from $161,323, for willful and repeated violations
$16,550, up from $16,131, each day for failure to abate after the abatement date
$16,550, up from $16,131 for serious, other-than-serious and posting requirement violations

The minimum penalty for a willful or repeated violation is now $11,823, up from $11,524 in 2024.

Executive Briefing (1/23/25) (members only)

Loss Control Alert: Top 10 Fed OSHA Violations. Fed OSHA released its list of the 10 most common OSHA violations (based on Oct 1, 2023–Sept 5, 2024 infractions). All violations on the latest list were also on the prior year’s list, but there was some reshuffling of the rankings. The biggest moves were caused by an increase of 378 respiratory protection violations, which moved that category up from the 7^th most common infraction to #4, and a decrease of 986 scaffolding violations, which moved that category down from #4 to #8 in the rankings. The #1 violation remains failure to adhere to the general requirements for fall protection.

Executive Briefing (1/23/25) (members only)

Other

CWCI 61^st Annual Meeting Save the Date. CWCI announced that our 61^st Annual Meeting will be held on Thursday, April 3, 2025 from 9 a.m. to 3 p.m. at the Sofia Tsakopoulos Center for the Arts in downtown Sacramento. The meeting will feature new research by CWCI staff, presentations by guest speakers, and lively interactive panel discussions. Continental breakfast will be available from 7:45 a.m. to 9 a.m., and a luncheon will be provided at noon. Additional details, including the agenda, guest speakers, and information on local accommodations are posted on our website.

Executive Briefing (3/21/25) (members only)

Executive Briefing (2/26/25) (members only)

Executive Briefing (1/23/25) (members only)

Executive Memo (3/18/25) (members only)

News Release (1/14/25) (public)

Gideon Baum to Succeed Alex Swedlow as President of CWCI. The CWCI Board of Directors named the Institute’s Chief Operating Officer, Gideon L. Baum, to succeed Alex Swedlow when he retires next summer as President of the Oakland-based research and educational organization.

Effective September 1, 2025, Mr. Baum will become the fifth President at CWCI in more than 60 years. Mr. Baum formally joined CWCI last year as Chief Operating Officer, where he focused on internal operations, public policy research, and representing the Institute’s members. Prior to joining CWCI, Mr. Baum was a Vice President of Policy at the California Hospital Association (CHA) from 2021 to 2024, representing CHA’s members on legislative and regulatory matters impacting the health care workforce. Prior to CHA, Mr. Baum served as a committee consultant of the California State Senate Committee on Labor and Public Employment. In this role, Mr. Baum was closely involved with the creation and passage of significant workers’ compensation legislation, including the 2012 workers’ compensation reform bill (Senate Bill 863), the 2015 formulary bill (Assembly Bill 1124), and the 2016 anti-fraud bill package (Assembly Bill 1244 and Senate Bill 1160)

News Release (1/6/25) (public)

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.

Quarterly Summaries Q4/24 (1/24/25) (members only)