CWCI Score Card Looks at Claims for Head and Spinal Injuries Without Spinal Cord Involvement

CWCI Score Card Looks at Claims for Head and Spinal Injuries Without Spinal Cord Involvement

The California Workers’ Compensation Institute (CWCI) has issued the third edition of its “Injury Score Card” featuring detailed data on California work injury claims for head and spinal injuries without spinal cord involvement, which represent only a small fraction of all workers’ compensation cases, but a disproportionate share of the costs, as they include catastrophic cases that are among the most expensive in the system. The Score Card reflects data from open and closed claims from accident years 2001 through mid-2011, which through June of last year had resulted in total paid losses of more than half a billion dollars.

The Score Card notes that for the 10½-year study period, head and spinal injuries accounted for only 1 out of every 200 California job injury claims, but due to the high average cost of these claims, they consumed 1.7% of paid losses. While strains, contusions and lacerations are the leading “nature of injury” categories for head and spine injuries, together they comprise less than half of the claims, while a relatively high proportion of head and spine claims involve fractures, concussions, multiple physical injuries and other cumulative injuries which are often expensive to treat and result in delayed return to work and high indemnity costs. Given this mix of injuries, medical-only cases comprise a relatively small share of the head and spinal injury claims (just over half of the claims vs. more than 2/3 of all injury claims in California), while a larger share of the claims are temporary disability cases (1 in 5 head and spine claims vs. 1 in 6 claims overall); and well over a quarter of the head and spine cases result in permanent disability payments, compared to only 1out of 6 claims overall. Unlike other types of injury claims, average paid losses on head and spinal injury claims never declined following the 2004 workers’ compensation reforms, with the most recent data (AY 2007-2009) showing that average paid losses on head and spine claims at 12, 24 and 36 months are 3 to 4 times higher than the average for all California workers’ compensation claims. For example, among AY 2007-2009 lost-time cases, average benefit payments at 36 months post injury for head and spine injury claims averaged $96,980 ($67,325 medical + $29,655 indemnity), compared to an average of $29,211 ($15,646 medical + $13,565 indemnity) for all California workers’ compensation lost time claims.

The latest Injury Score Card also features a profile of head and spine injury claimants and claim distributions by industry sector, claimant county of residence, and cause of injury. In addition, several Score Card exhibits compare the results for spine disorder claims to those for all California workers' compensation claims (these include the exhibits showing the percentage of claims with PD payments within 3 years of injury; the attorney involvement data; the claim closure data; the prescription drug distributions; the breakdowns of medical development by Fee Schedule Section at 12 and 24 months post injury; the notice and treatment time lags; the medical network utilization rates; and the 12-, 24- and 36-month loss development).

CWCI’s Injury Score Card Series and summary Bulletins are available to Institute members and research subscribers who log on to CWCI’s web site, www.cwci.org. Anyone wishing to subscribe may do so by visiting CWCI’s online Store. The next Score Card in the series will focus on claims involving sprains of the shoulder, arm, knee and lower leg.