What the New CWCI Study Means For You

Recent research done by the CWCI about professional medical service treatment patterns has revealed that the utilization of professional medical services in California's workers' compensation claims has remained relatively stable over recent years, with only slight fluctuations being observed within two years for indemnity claims with initial treatment dates between 2014 and 2019, while a similar pattern was detected within six months of 2018 to 2021.

Purpose of the Study

This study aimed to evaluate the pattern of Medical Services administered to California Injured Workers following 2012's workers' compensation reforms (SB-863) and determine any interruptions in initial medical services caused by the COVID-19 pandemic.

What it discovered

Analyzing non-COVID indemnity claims data from the Industry Research Information System (IRIS) database, this study presents results on professional medical services for major surgeries within two years of an initial treatment date. By calculating the percent of claims with and without a major surgery that employed Evaluation & Management, Physical Medicine, Advanced Imaging, Mental Health, and Injection services in each respective treatment year, some of its key findings revealed:

1. Steady decreases in major surgery-related indemnity claims have been observed since 2014. In only 5 years, the share of such cases has diminished from 28% to 23%.

2. For the first two years of its implementation, Advanced Imaging remained fairly consistent in terms of usage for both claims without major surgery and surgical claims. Specifically, it ranged from 40-42% for non-surgical cases and 61-64% for those involving surgery.

3. During the six-year period of this survey, surgical claims had approximately seven to nine more E&M visits during the first two years than those dealing with no major surgery.

4. Data collected over a six-month period on claims with initial service dates ranging from 2018 to 2021 showed that the prevalence or amount of early treatment provided was not significantly affected by disruptions in medical services due to the pandemic.

5. Even though the overall proportion of claims utilizing Mental Health services remained relatively unchanged since the beginning of the pandemic, there was a significant rise in average visits to Mental Health professionals within two years.

6. Even after the pandemic began, there was a minimal alteration in the proportion of statements that incorporated Physical Medicine services during their first 24 months. Claims with major surgery averaged approximately 26 visits to a Physical Medicine specialist within two years - more than twice as much as those without such operations.

7. While a measly 5-6% of claims without surgery and 6-7% went on to receive Mental Health services in the first two years of treatment, there was little variation between those who had initial treatments during 2018 or 2019.

8. Approximately 50 percent of all claims that included surgery also featured Injections, whereas just 17 to 18% of claims without major surgical intervention had Injections administered.

What does this mean for you?

This research shows that the utilization of professional medical services in California's workers' compensation claims has remained relatively stable over recent years, with only slight fluctuations being observed. It also indicates that even during the pandemic period, there was little disruption to medical service delivery and little change in the prevalence or volume of early treatment provided. This is good news for those requiring workers' compensation claims as it means they can access reliable and consistent healthcare without worrying about disruptions caused by the pandemic.

Furthermore, this research suggests that there is no need to worry about any sudden changes in terms of access and quality. This data should be useful for employers and insurers when considering their own policies, as well as providing valuable insight into the state of medical service delivery and workers' compensation claims in California.

If you have any questions about your rights or responsibilities related to making a claim under workers’ comp law, please contact us at Cole, Fisher, Cole O’Keefe + Mahoney today. Our experienced specialists are here to help answer all of your questions so you can make an informed decision regarding filing a claim.

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Cole, Fisher, Cole, O’Keefe + Mahoney is Central California’s leading workers’ compensation and social security disability law firm. With over 30 years of successful experience, we are committed to securing maximum benefits for our clients in the Fresno, California area. Schedule a free consultation today.