JULY 8, 2015: Today, the WCIRB released the California Medical Payment Development Up to 30 Years Post-Injury report examining California’s longer than average medical payout pattern. This WCIRB study analyzed data from approximately one million claims ($4.4 billion in medical payments) sorted into seven cohorts based on dates of injury and current medical treatment.

WCIRB researchers found that California has the most prolonged workers’ compensation treatment pattern in the country, and as claims mature, patterns of treatment evolve as prescriptions for narcotics and psychoactive drugs, treatment of chronic medical problems of aging that are unrelated to the acute injury, and complications caused by post-injury medical treatment all become more prevalent. Other observations from the report include:

  • 17% of the claims studied lasted three years or more, accounting for $1.5 billion (35%) of total medical payments.
  • The total share of prescription narcotics, especially Oxycontin, grew as claims developed over time. Additionally, shares of prescribed psychoactive drugs, such as sedative hypnotics, stimulants and anti-depressants increased with the age of the claim.
  • The share of payments for acute injuries (fractures, wounds, dislocations, sprains and strains) declined as claims aged. Conversely, the share of medical payments for chronic medical conditions, such as cardiac, respiratory and digestive problems increased as claims age.
  • Complications from medical care — a medical condition not likely associated with the initial injury — gradually increased with the age of the claim.
  • California does not have more hazardous employment, older workers, more severe injuries or worse medical conditions than other states. However, in California, medical treatment continues and claims remain open for a longer period than in other states.

Researchers also compared 20 to 30 year old California claims with a similar national cohort and found that all late-term claims have similar medical treatment patterns; however, nationally, a much greater share of injuries are resolved within three years of the date of injury. California is unique in that it allows a greater proportion of prolonged treatment and enables acute conditions to become chronic medical problems.

The complete report is available in the Research and Analysis section of the WCIRB website.


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