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Analysis of Cumulative Trauma & Litigated Claims in California Workers' Comp

CT & Litigated Claims in California Workers' Comp. A CWCI Research Note based on 1.4 million claims with claims administrator notification dates ranging from 2010 through 2022 tracks the growth of CT claims in California workers' compensation and examines the impact that factors such as region, tenure, industry, age, and average weekly wage have on the likelihood of CT claims.

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CWCI Analysis of California WC Inpatient Care, 2012-2022

A CWCI Research Update report uses HCAI data to monitor trends in the utilization of inpatient care in California workers comp from 2012 through 2022, comparing the workers comp trends to those in Medicare, Medi-Cal and private coverage. The report also reviews changes in the types of conditions treated and the services delivered to injured workers before and after the pandemic was declared in 2020; takes a focused look at the primary diagnoses underlying inpatient hospitalizations involving spinal fusions and major joint replacement surgeries; and examines how the growth of outpatient surgery is affecting the total number of injured worker hospitalizations.

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Claims Monitoring: Medical and Indemnity Development, AY 2013 - AY 2022

A CWCI analysis of data from the IRIS database tracks average California workers' comp total losses per indemnity claim since the implementation of SB 863 through the first three years of the pandemic, and breaks out the data to show both paid medical and paid indemnity loss trends. The study also looks at 24-month loss trends for claims from five key industry sectors and for claims from injured workers living in 7 distinct regions of the state as well as from workers living out of state.

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Cost-Driver Medications in the Top California Workers' Comp Therapeutic Drug Groups: Part 3, Musculoskeletal and Ulcer Drugs

The final report in a 3-part research series on workers' compensation medications that represent a relatively small share of the dispensed prescriptions within their therapeutic drug group, but due to their high average reimbursements, account for a disproportionate share of the total drug spend within their group. Part 3 of the series focuses on Musculoskeletal and Ulcer Drugs.

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An Analysis of AB 1213's Proposed Change to the 104-Week TD Cap

CWCI examines a proposal to alter the TD cap by excluding TD that is paid or due from the UR treatment denial date to the date of the treatment authorization if the denial is overturned by IMR or the WCAB. The analysis estimates the percentage of claims that would be affected by the proposal in light of the required IT costs to update claims systems and the ongoing administrative costs for manual processes to identify and track claims with TD payments and UR and IMR activity.

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Cost-Driver Medications in the Top California Workers' Comp Drug Groups: Part 2, Dermatologicals, Opioids, and Antidepressants

The second in a 3-part research series on workers' compensation medications that represent a relatively small share of the dispensed prescriptions within their therapeutic drug group, but due to their high average reimbursements, account for a disproportionate share of the total drug spend within their group. Part 2 of the series focuses on Dermatologicals, Opioids, and Antidepressants.

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CWCI Report to the Industry Examines Factors that Drive IMR Volume and Outcomes

A new CWCI Report to the Industry provides an in-depth look at the dispute resolution process in California workers compensation and examines IMR activity and outcomes from 2014 through 2022.

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Patterns in the Provision of Professional Medical Services in California Workers Compensation

CWCI research tracks changes in the prevalence and volume of professional medical services in the first 2 years of treatment for indemnity claims in which medical care began between 2014 and 2019. To examine the impact of the pandemic, the authors compare the prevalence and volume of services in the first 6 months of treatment for claims in which treatment began in 2018 and 2019 claims in which treatment began in 2020 and 2021. In both cases, results are broken out for claims with and without surgery.

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Cost-Driver Medications in the Top California Workers' Comp Drug Groups: Part 1, Anti-Inflammatories & Anticonvulsants

The first of a 3-part research series on workers' compensation medications that represent a relatively small share of the dispensed prescriptions within their therapeutic drug group, but due to their high average reimbursements, account for a disproportionate share of the total drug spend within their group. Part I of the series focuses on Anti-Inflammatories and Anticonvulsants.

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Trends in the Utilization of Inpatient Care in California Workers' Compensation

A Research Update report that continues CWCIs series of studies examining inpatient utilization trends using data compiled by the California Department of Health Care Access and Information. The analysis compares the volume and types of inpatient hospitalizations covered by workers compensation to those covered by Medicare, Medi-Cal, and private coverage.

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Underlying Issues and Outcomes in Reducing the Compensability Determination Timeline

In both 2021 and 2022, California legislators have debated proposals that would shorten the compensability determination timeline for California workers compensation claims. This CWCI Impact Analysis report helps bring the debate into focus by providing background information on the compensability determination process for litigated and non-litigated claims, reviewing existing statutory and regulatory timeframes for various steps within the process, and using data from nearly 460,000 non-COVID-19 claims and more than 17,000 COVID-19 claims to evaluate the need for and the potential impact of the proposals, including the unintended consequences.

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An Early Look at the Impact of the New Med-Legal Fee Schedule

CWCI research takes an in-depth look at the impact of the Med-Legal Fee Schedules revised reimbursement rules and fees by comparing various utilization and payment metrics from before and after the schedule took effect on April 1, 2021. Read the full report.

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Independent Medical Review Decisions: January 2015 Through December 2021

CWCI's latest update on Independent Medical Review, derived from IMR decision letters from 2015 through 2021, measures changes in IMR volume, shifts in the mix of services reviewed; changes in IMR response times; regional variations; and IMR uphold rates by medical service category. The study also looks at the distribution of prescription drug IMRs and uphold rates by drug category; the proportion of IMRs involving medical service request modifications among six treatment categories; and the concentration of IMR activity among high-volume physicians named in IMR letters.

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Can Access to Medical Care in California Workers' Compensation Be Improved?

CWCI takes a detailed look at issues surrounding injured worker access to medical treatment in California workers compensation. The study measures the average and median days to initial treatment for various services and injured workers proximity to care, and notes provider perspectives, gleaned from individual interviews, on the administrative burdens associated with rendering care in the workers' compensation system.

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California WC Inpatient Hospitalization Trends, 2010-2020.

A CWCI Research Update report uses OSPHD data to track changes in the volume and types of inpatient hospitalizations in California workers compensation from 2010 through 2020 and compare workers compensation inpatient hospitalization trends to those in Medicare, Medi-Cal and private coverage. While updating the long-term inpatient hospitalization trends, the report also provides a focused look at the changes in inpatient hospitalizations between 2019 and 2020, highlighting the impact of COVID-19 on California workers compensation inpatient care, identifying changes in the types of conditions treated and the services delivered to injured workers during the first year of the pandemic.

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COVID-19 Death Claim Trends and Characteristics

COVID-19 Death Claims: a new CWCI report takes an in-depth look at the trends and characteristics associated with 1,032 California workers compensation death claims from the first 18 months of the pandemic. The report tracks changes in the number of COVID and non-COVID death claims from January 2020 through June 2021 as well as changes in the percentage of all death claims ascribed to COVID during that 18-month span, and compares the distributions of COVID death claims vs. all COVID claims, and non-COVID death claims based on the workers age and gender, as well as by region and industry.

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CWCI Analyzes Bill to Cut WC Claim Investigation Times & Increase Employer Medical Liability

A CWCI report examines SB 335, a bill that would cut the amount of time claims administrators have to investigate job injury claims and increase employers liability for medical benefits during the investigation period by 70%.

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AB 1465 and Medical Provider Networks in the California Workers' Compensation System

A CWCI analysis of a 2021 legislative proposal (AB 1465) intended to increase injured workers access to medical care by requiring the state to create a medical provider network (CAMPN) as an alternative to private networks that render 90 percent of California workers' compensation treatment. The report provides background information on the use of medical networks in California workers' compensation, reviews how the proposed statewide network would be structured, and evaluates the potential for improving injured worker access to care. The analysis includes data on time to initial treatment and injured worker proximity to treating providers for current MPN and non-MPN claims, shows the percentage of injured workers treated within and outside MPNs who meet the states access to care standards, notes the average distances these workers must travel to receive primary care and surgery services, with results broken out for urban, suburban and rural residents, and estimates the cost of building and maintaining the CAMPN.

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IMR Decisions: January 2014 Through December 2020.

A CWCI Research Update report documents the sharp decline in IMR volume in 2019 and 2020, fueled by the reduction in prescription drug IMRs and the economic slowdown brought on by the COVID-19 pandemic in 2020. The report also looks at the distribution of IMRs and IMR outcomes by medical service category, regional distributions, IMR response times, and examines the distribution of pharmaceutical IMRs among therapeutic drug groups.

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