Q2, 2017 – July 24, 2017
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Research Study Links Higher Initial Opioid Quantities to Long-Term Use. A new study, summarized in the CDC’s March 17 issue of the Morbidity and Mortality Weekly Report links the initial supply of opioids given to a patient to the duration of usage. The study suggests that the larger the quantity of opioids initially prescribed to a patient, the higher the odds that they will still be taking them a year later, and found that about 1 out of 7 patients whose 1st-time opioid Rx exceeded a 1-week supply of the painkillers were still on the drugs a year later, while 3 out of 10 patients whose initial Rx exceeded a 1-month supply were still taking the opioids a year later. The study further supports limiting initial supplies of opioids prescribed to injured workers, as proposed in the current draft of the Calif WC Rx drug formulary. Executive Briefing (6/26/17) (members only) California Workers’ Comp Claim Distribution by Industry. CWCI’s recent Regional ScoreCard Series divided Calif into 8 distinct regions then used claims data from the IRIS database to generate detailed data on claims experience in each region. Combining the data from the 8 regions provided a snapshot of statewide experience that showed the distribution of AY 2005-15 claims by industry sector. While claim distributions varied significantly among the 8 regions, statewide the data show that workers employed in manufacturing filed the most claims over the 11-year span, closely followed by healthcare workers, employees working in retail trade, and construction workers. Together these 4 sectors accounted for nearly half (47.5%) of all claims in the state. Four other sectors had at least 5% of the claims, including hotel and food service (8.7%); clerical (7.2%); agriculture (6.8%) and transportation and warehousing (5.7%), though notably, unlike the top 4 sectors, claims in these 4 sectors were often concentrated in specific regions and not necessarily widespread throughout the state. Executive Briefing (6/26/17) (members only) CWCI Debuts Interactive Application for Members Using Data from WC Spinal Fusion Claims Study. As a complement to its March 2017 analysis of spinal fusions in California workers’ compensation, the Institute developed an interactive application that allows members to take a deeper dive into the OSHPD spinal fusion data. Executive Briefing (5/24/17) (members only) Executive Memo (5/12/17) (members only) Distribution of California Workers’ Compensation 2016 DWP Among Top 20 Insurer Groups. CWCI’s analysis of NAIC data released by the Department of Insurance finds that total workers comp DWP in California increased to nearly $13 billion in 2016 and notes the shifts in the rankings of the top 20 insurer groups based on premium volume. Bulletin (5/22/17) (members only) Injury Classification in California Workers’ Comp, Part 1: Medical Coding During the ICD-10 Transition. An analysis on the use of ICD-10 codes in California workers comp during the transition from the ICD-9 system. The study showed that 99 percent of submitted medical bills used ICD-10 codes and, as expected, a wider range of codes were provided than in the past, but many lacked the additional characters that better define the injury, identify the type of encounter and improve communication. Research Update (5/17/17) (members only) Bulletin (5/17/17) (members only) Executive Briefing (5/24/17) (members only) News Release (5/17/17) (public) NAIC Report on Insurer Profitability in 2015. CWCI’s summary of NAIC data showed California workers comp insurers return on net worth rose for the second year in a row in 2015, increasing from 5.8% to 7.9%. California workers comp insurers average return for the 10-year period ending in 2015 was 7.3%. Bulletin (4/18/17) (members only) California Workers’ Comp Regional Score Card: Sierras. The final installment of CWCI’s 8-part series of Regional Score Cards provides detailed data derived from 32,000 AY 2005-2015 job injury claims filed by residents living in the 11-county region runs from the foothills of the Gold Country east to the Tahoe Basin and along the mountainous eastern flank of the state from Sierra County south to Inyo County. The Score Card measures key aspects of Sierra claims and compares the results to those from other regions. Although workers living in the Sierras represent just 1.7% of California workers’ comp claims and a relatively low level of litigation, the Score Card shows that over the past decade average loss payments in the region have grown faster than in other parts of the state. Regional Score Card (4/11/17) (public) Bulletin (4/11/17) (members only) News Release (4/11/17) (public)
Statutory/Regulatory TTD/PTD Rates to Increase 1/1/18. The Department of Labor announced California’s State Average Weekly Wage (SAWW) rose more than 3.6% for the 12 months ending 3/31/17, so temporary total disability (TTD) and permanent total disability (PTD) rates for injuries o/a 1/1/18 will increase as well because LC §4453(a)(10), a 2002 reform, tied minimum and maximum TTD and PTD rates to annual increases in the SAWW. The latest increase should boost maximum TTD and PTD to $1215.27/week for 2018 injuries, and bump the minimum to $182.29/week. Bulletin (6/14/17) (members only) Executive Briefing (6/26/17) (members only) Executive Memo (6/14/17) (members only) News Release (6/14/17) (public) Formulary Progress Report. AB 1124 required that the DWC adopt an evidence-based drug formulary as part of the MTUS by July 1, 2017, but after getting an earful on its proposed formulary at a public hearing in May, including many comments suggesting that implementation be delayed beyond July 1, the DWC said it will modify the proposed regs and accept written comments on the modifications during a 15-day comment period. While it does still anticipate that the regs will be adopted this summer, DWC plans to make them effective January 1, 2018. Executive Briefing (5/24/17) (members only) Fed-OSHA Postpones New Electronic Injury Reporting Rules for Employers. Fed-OSHA announced that it will delay the implementation of a rule requiring certain businesses to electronically submit work injury data, which had been scheduled for 7/1/17. No effective date for implementation was announced. Executive Briefing (5/24/17) (members only) Member Alert: 2017 Adjuster/Medical Bill Reviewer Certification (WCAC) Data Call Deadlines. Advisory notice to CWCI members that the Dept. of Insurance had notified CWCI that it was issuing the Workers’ Comp Adjuster Certification (2017 WCAC) Data Call for claims adjuster and medical bill reviewer data, and that the WCAC “Acknowledgement of Receipt Form” would be due by Friday, May 19 and insurers would need to submit a completed Data Workbook to certify their adjusters and/or medical bill reviewers by Friday, July 7. Executive Memo (4/21/17) (members only)
Legal CWCI, CalChamber & CCWC File Amicus Brief in Stevens v. WCAB. CWCI, the California Chamber of Commerce and the California Coalition on Workers’ Compensation filed a joint amicus brief in Stevens v. WCAB, the long-running court case that challenged the constitutionality of the UR/IMR process for resolving WC medical disputes. Amicus by CWCI, CalChamber, and CCWC (6/22/17) (members only) Executive Briefing (6/26/17) (members only) News Release (6/22/17) (public) Hikida v. WCAB (Costco). In a published decision from the Court of Appeal, the court held that disability resulting from medical treatment for which the employer is responsible is not apportionable. While the law relieves the defense from liability for negligence in the provision of medical treatment, it does not relieve the defense of the obligation to compensate the injured worker for the resulting disability without apportionment. Significant Decision Summary (6/29/17) (members only) Ramirez v. WCAB. The Court of Appeal held that the Legislature’s plenary authority over UR and IMR was sufficient to overcome applicant’s constitutional challenges to the medical dispute resolution process. The applicant filed a Petition for Review with the Supreme Court. CWCI wrote a letter in opposition to that Petition and the applicant’s Petition for Review was subsequently denied. CWCI Letter in Opposition to Petition for Review (05/11/2017) Southern Insurance v. WCAB (Berios-Segovia). The Court of Appeal ruled that an arbitrator was incorrect when he found that, as a matter of law, the insurer could not rescind a workers’ compensation insurance policy based on an allegation that policy was procured by fraud. The decision outlines the correct procedures to rescind a workers’ comp policy and to enforce the rescission. The appellate decision was ordered published on May 22, 2017. Significant Decision Summary (5/22/17) (members only) City of Jackson v. WCAB (Rice). In a published decision, the Court of Appeal held that apportionment to causation may properly include apportionment to a combination of genetic and environmental factors. The Court concluded that there is no relevant distinction between allowing apportionment based on a preexisting congenital or pathological condition and allowing apportionment based on a preexisting degenerative condition caused by heredity or genetics. Applicant subsequently filed a Petition for Review at the Calif Supreme Court on 6/6/17. Significant Decision Summary (4/26/17) (members only)
Other CWCI Debuts Redesigned Website. The Institute has overhauled its website, offering users a bold new look and feel along with streamlined navigation making it easier to access important publications, reports, educational content, online interactive tools, and a revamped store that makes it easier to order products or publications and to register for CWCI educational programs. Check out the new site at www.cwci.org, Executive Briefing (6/26/17) (members only) Minutes from the Claims and Medical Care Committee Meeting. Claims and Medical Care Committee Meeting Minutes (6/13/16) (members only) Minutes from the Legal Committee Meeting. The meeting was held Thursday, May 4 by conference call. The agenda included status reports on CWCI amicus activity (Ramirez v. WCAB;Hallmark v. WCAB (Southard) and Baker v. WCAB; Rice v. WCAB; Zuniga v. WCAB; and King v. CompPartners); a report on Chamber of Commerce activity by Saul Allweiss; an update on regulations (drug formulary; lien claim filings; provider suspension rules); a review of WC bills from the current session; and presentation by attorney David Skaggs on Medicare class action lawsuits. Legal Committee Meeting Minutes (5/4/17) (members only) Commissioner Approves 7.8 Percent Mid-Year Advisory Pure Premium Rate Cut. Insurance Commissioner Jones approved a reduction in the workers’ comp advisory pure premium rates averaging 7.8 percent for new and renewal policies incepting on or after July 1, 2017. Executive Briefing (5/24/17) (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 Q1/17 (4/4/17) (members only) |