CWCI Scorecard Examines California Workers’ Comp “Other Injury, Poisoning & Toxic Effect” Claims

A new California Workers’ Compensation Institute (CWCI) “Injury Scorecard” on job injury claims identified as “other injuries, poisonings and toxic effects” finds that these claims often involve non-specific or ill-defined diagnoses; are more likely than other claims to involve attorneys and permanent disability payments; take longer to close; result in above average loss payments; and a disproportionate share of them (32.5%) are filed by Los Angeles County residents. CWCI compiled data for the Score Card from 169,287 open and closed claims for 2001-11 injuries in which the primary diagnosis fell into the “other injury, poisoning and toxic effect” category. As of January 2012, medical and indemnity benefit payments on those claims totaled nearly $3.1 billion.

The Score Card shows that during the 11-year span of the study, “other injury, poisoning and toxic effect cases accounted for 7.7% of California’s workers’ compensation claims, but 10.1% of workers’ compensation loss payments, as more than 1 out of every 5 of these injuries resulted in a permanent disability payment (vs. 1 in 6 injury claims overall), nearly 2/3 of the lost-time claims in this category involved an attorney (vs. less than half of all lost-time claims), and PD claims in this category took longer to close than other PD claims. Notably, during the pre-reform era of 2001-03, average paid losses on other injury, poisoning and toxic effect claims were below the average for all claims, but unlike other types of injury claims, loss payments on these claims never declined following the 2002-2004 workers’ compensation reforms, and have remained above average since 2004. For example, the Score Card shows average loss payments at 36 months post injury on AY 2001-03 other injury, poisoning and toxic effect indemnity claims totaled $26,512 ($12,891 medical + $13,622 indemnity), or 8.9% less than the average for all indemnity claims. But, while average 36-month losses for all indemnity claims fell 13.9% in the 3 years after the reforms, average payments on indemnity claims in this category rose 17% to $31,015; then continued up for 3 more years, rising 30.7% to $40,547 ($23,801 medical + $16,746 indemnity) for AY 2007-09 claims – 38.8% above the average for all indemnity claims from the same era.

Aside from tracking average paid losses for 2001 through 2009 other injury, poisoning and toxic effect claims at 12-, 24- and 36-months post injury, the CWCI Score Card provides a profile of claimants in this injury category, as well as claim distributions by industry sector, the claimants’ county of residence, and cause and nature of injury. Several exhibits also compare other injury, poisoning and toxic effect claim results to those for all California workers' compensation claims (these include exhibits showing the percentage of claims with PD payments within 3 years of injury; attorney involvement data; claim closure data; prescription drug distributions; breakdowns of medical development by Fee Schedule Section at 12 and 24 months post injury; notice and treatment time lags; and medical network utilization rates).

In addition to the Score Card on “other injury, poisoning and toxic effect” claims, recent Score Cards have examined medical back problems with and without spinal cord or root involvement; shoulder, arm, knee and leg sprains; head and spinal injuries without spinal cord involvement; and carpal tunnel syndrome. Injury Score Cards and summary Bulletins are available to CWCI members and subscribers who log on to www.cwci.org.