Q2, 2018 – September 27, 2018
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Research Initial Data on CY 2017 Insured Losses & Expenses. WCIRB’s Annual Report on Insured Losses and Expenses for CY 2017 shows medical payments totaled $4.7 billion, 56% of total paid losses. Physician services and payments directly to injured workers each accounted for $1.3 billion; $0.7 billion paid for inpatient & outpatient services; $0.2 billion paid for Rx drugs, and $0.3 billion paid for med-legal. Medical cost containment on insured claims totaled $443 million, down from $468 million in 2016; total paid indemnity for insurers was $3.7 billion, or 44% of total loss payments, with the 2 biggest indemnity components being TD ($1.8 billion) and PPD ($1.5 billion). Incurred losses + expenses totaled $16.2 billion, or 91% of premium, down 4.1 percent from $16.9 billion, or 94% of CY year premium in 2016. Executive Briefing (6/27/18) (members only) IMR Volume & Outcomes Hold Steady in Q1 2018. The latest IMR results from a CWCI review of IMR decision letters issued in the first 3 months of 2018 in response to applications sent to the DWC after a utilization review physician modified or denied a medical service requested for an injured worker. The data show that the medical dispute resolution process established as part of the 2012 workers’ comp reforms continues to produce consistent outcomes, with little change in the number of IMR determination letters and decisions; the percentage of modified or denied treatment requests that are upheld; the types of treatment requests reviewed; and the small number of physicians who are linked to a majority of the disputed requests. Bulletin (6/15/18) (members only) News Release (6/15/18) (public) Executive Briefing (6/27/18) (members only) Update on Public Self-Insured Experience Through FY 2016/2017. The Institute’s review of public self-insured claims experience in the California workers’ compensation system for the fiscal year ending 6/30/17. The Institute examines the initial data on private self-insured claim volume and frequency as well as paid and incurred costs derived from data reported to the Office of Self Insurance Plans, and compares these results to similar initial report data from the past 10 years. Bulletin (6/20/18) (members only) Executive Briefing (6/27/18) (members only) California WC Direct Written Premium and Market Share Update for 2017. California workers’ comp total direct premium edged down 1.5% in 2017. CWCI reviews the NAIC data released by the Dept. of Insurance and notes the shifts in market share among the largest insurers. Bulletin (5/31/18) (members only) Summary of NAIC Data on Calif WC Insurer Profitability for 2016. The latest NAIC data show California workers’ comp insurers return on net worth rose from 7.9% in 2015 to 8.7% in 2016, the third consecutive increase. For the 10-year period ending in 2016, California workers comp insurers average return was 6.6%. Bulletin (5/21/18) (members only) California Workers’ Compensation Inpatient Hospitalization Trends. CWCI research that measures and compares changes in the volume of inpatient hospitalizations in California Workers’ Comp, Medicare, Medi-Cal and private plans from 2008-2016, notes the most common WC inpatient diagnosis-related group codes (MS-DRGs) and the top 5 Major Diagnostic Categories (MDCs); and provides detailed data on other workers’ comp inpatient trends, including average length of stay and changes in the volume of implant-eligible spinal surgeries. Research Update Report (5/03/18) (members only) Bulletin (5/03/18) (members only) News Release (5/03/18) (public) Insured Experience Through Q4 2017. CWCI’s summary of the latest WCIRB data showing statewide WC insurer loss & premium experience through Q4 2017. Executive Briefing (4/27/18) (members only) CWCI Prescription Drug Interactive Tool. An online application that CWCI members can use to examine and compare industrywide prescription drug data derived from 12.5 million prescriptions dispensed to injured workers between January 2007 and June 2017. CWCI Interactive Research Report (4/25/18) (members only) Interactive Application Tool (4/25/18) (members only) Executive Briefing (4/27/18) (members only) Executive Memo (4/25/18) (members only)
Statutory/Regulatory WC Benefits Set to Increase in 2019. On 12/7/17, OAL approved MTUS Formulary regs submitted by DWC and filed them with California’s State Average Weekly Wage (SAWW) rose just under 3 percent in the year ending March 31, 2018, which the DWC reports will boost temporary total disability and permanent total disability rates for 2019 work injury claims and other California workers’ comp benefits that are tied to SAWW increases. The Division notes that the 2.971 percent increase in the SAWW reported by the Department of Labor means the TD maximum will rise to $1,251.38 per week for claims with injury dates on or after January 1, 2019 while the TD minimum will rise to $187.71. Bulletin (6/26/18) (members only) Executive Briefing (6/27/18) (members only) Executive Memo (6/26/18) (members only) News Release (6/26/18) (public) Insurance Commissioner Approves 10.3% Pure Premium Rate Reduction. On May 29, Insurance Commissioner Dave Jones issued his decision on WCIRB’s proposed mid-year reduction in advisory pure premium rates, calling for a 10.3% reduction in the rates to an average of $1.74/$100 of payroll for new and renewal policies issued o/a 7/1/18. Executive Briefing (6/08/18) (members only) No CIGA Surcharge for Policies Incepting in 2019. CIGA’s Board announced that with recent favorable loss development the Association’s WC reserve situation has improved significantly, so it has approved a zero assessment for PY 2019 — the first time in 19 years, WC insurers will not need to advance any funds to CIGA in July, nor will they need to add a CIGA surcharge to policies incepting in 2019. Executive Briefing (6/08/18) (members only) Mid-Year Legislative Update: CWCI’s summary of 10 California WC legislative proposals that were still alive as of June. Executive Briefing (6/08/18) (members only) Proposed Changes to the Medical Legal Fee Schedule: CWCI’s comments to the first public forum on draft revisions to the Med-Legal Fee Schedule. Forum Comment (5/18/18) (public) Mandate that Docs Check CURES Takes Effect October 2. On April 2, more than 1-1/2 years after SB 482 was signed, the Calif Dept of Justice certified that the database is ready for statewide rollout, so the clock is now ticking toward an Oct. 2 deadline for doctors who prescribe opioids or other Schedule II, III or IV drugs to begin consulting CURES prior to prescribing these drugs. Executive Briefing (4/27/18) (members only) RBRVS Physician Fee Schedule. CWCI’s comments on revisions to the physician fee schedule submitted during the 30-day public testimony. 30-Day Public Testimony (4/17/18) (public) Proposed Interpreter Fee Schedule: CWCI’s comments submitted during the second public forum on the Proposed Interpreter Fee Schedule. Forum Comment (4/13/18) (public) WCIRB Recommends 7.2% Cut in the Advisory Pure Premium Rate…Following its report on insured loss & loss-adjustment expenses through 2017, WCIRB recommended a 7.2% mid-year pure premium rate cut — the 6th such reduction since Jan. 2015. If approved by the Ins. Commissioner Jones, the reduction would push the avg pure premium rate/$100 of covered payroll down from $1.94 to $1.80, which translates to a net reduction of 35% over the past 3-1/2 years. Executive Briefing (4/27/18) (members only)
Legal Black v. Corvel. A group of police officers and firefighters in Rialto and Stockton have claimed RICO violations and fraud for bad-faith case handling. After four amended complaints, the trial judge found that the plaintiffs could not state a viable cause of action, and dismissed the case. The plaintiffs have appealed the dismissals to the Ninth Circuit Court of Appeals, and the case is currently in the briefing stage. CWCI filed an amicus brief in support of the defense. Amicus Brief (6/18/18) (members only) 4th DCA Ruling in Pike Prohibits TD for Disability Periods Beyond 5 Years from Injury Date. In a published opinion from March 2018, County of San Diego v. WCAB (Pike), the 4th DCA reversed a WCAB ruling and held that the Board lacks authority to award benefits that are expressly prohibited by the plain language of LC §4656(c)(2), which prohibits TD for periods after 5 years from a post-1/1/08 DOI, even if the case was timely reopened and TD started within 5 years from DOI. CWCI filed an amicus brief in support of the defendants in the case. As a result of the ruling, neither TD nor salary continuation benefits under LC §4850 may be awarded for periods of disability beyond 5 years from the original DOI. Executive Briefing (6/27/18) (members only) The Dynamex Decision: Calif Supreme Court Rules on Employee/Contractor Classification: On 4/30/18 a Calif Supreme Ct ruling in Dynamex Operations v. Superior Ct adopted a new, stricter standard for determine whether a worker can be classified as an independent contractor rather than as an employee. Significant Decision Summary (6/20/18) (members only)
Other Minutes from the Claims/Medical Care Committee Meeting. The meeting was held June 12 at CWCI in Oakland. The agenda included presentations of recent CWCI research on variations in MPN outcomes; the impact of the copy service fee schedule; prescription drug utilization and cost; and IMR outcomes. Current legislative proposals addressing PD ratings on breast cancer claims, changes to the RTW fund, coverage for off-duty police injured outside of the state; debit cards for TD, and apportionment were reviewed. An update on regs covered changes in the MTUS drug list; geographic adjustments to the OMFS; proposed changes to the MLFS, and the development of the interpreter fee schedule. Meeting Minutes (6/12/18) (members only) FDA Expands Warning on Mixing Opioids & Benzodiazepines. With the growing prevalence of medication-assisted treatment (MAT) plans that use these drugs, the FDA now requires an expanded warning label noting that combining the drugs increases the risk of serious side effects; but the harm caused by untreated opioid addiction usually outweighs these risks; and that careful medication management by health care professionals can reduce the risks. The FDA also requires detailed recommendations for minimizing the use of MAT drugs and benzodiazepines together. Executive Briefing (6/08/18) (members only) Minutes from the Legal Committee Meeting.The meeting was held May 10 by webinar. The agenda included an update on regulations on the formulary, utilization review, interpreter fees, physician fees, and the RTW Fund; status reports on CWCI amicus activity (Gomez; King; Pike, Black, Alzayat v. Herb, Fitzpatrick); a discussion of the Supreme Ct. ruling in Dynamex; a review of current WC bills dealing with breast cancer ratings, coverage of off-duty police officers out of state, medical cannabis, debit cards, and apportionment; a review of recent DWC appointments; and an update on the litigation environment. Meeting Minutes (5/10/18) (members only) CMS Rule Change Could Alter WCMSA Set-Asides for Opioids. (CMS) issued a final rule change detailing Medicare Advantage Plan & Medicare Part D policy changes, including changes that address a Comprehensive Addiction and Recovery Act of 2016 requirement that CMS adopt a regulatory framework for Part D Medicare Rx plans to implement drug management programs that, beginning in 2019, will limit at-risk beneficiaries’ coverage for frequently abused drugs such as opioids & benzodiazepines. Once the rules take effect for Part D recipients, CMS may extend them to WCMSA approvals in cases where injured workers are treating with high-dosage opioids. Executive Briefing (4/27/18) (members only) DIR Director Christine Baker Announces Her Retirement. In a surprise announcement, Christine Baker, the Director of the Dept. of Industrial Relations, who played a key role in the enactment of SB 863, Governor Brown’s overhaul of the workers’ comp system, announced her retirement. Executive Memo (4/02/18) (members only) CWCI Quarterly Summaries 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. Quarterly Summaries Q1/18 (04/01/18) (members only) |