CWCI Scorecard Looks at Spinal Disorder Claims in California Workers’ Comp

CWCI Scorecard Looks at Spinal Disorder Claims in California Workers’ Comp

The California Workers’ Compensation Institute has released the second edition of its “Injury Scorecard” research series, providing detailed data on accident year (AY) 2001 to 2011 workers’ compensation claims experience for cases in which the primary diagnosis was a spine disorder with spinal cord or root involvement. The new Scorecard is based on an analysis of 30,293 California job injury claims that resulted in total payments of more than $2.1 billion. The Scorecard notes that over the 11-year span of the study, these “spine disorder” claims accounted for only 1.4% of California job injury claims, but 6.9% of all paid losses.

The most common diagnoses for this injury category are thoracic or lumbosacral nerve inflammation or nerve root inflammation, which comprise 36% of job-related spine disorders, followed by displaced discs (19%), lumbar region disc disorders involving the spinal cord (11%), and compression or irritation of the sciatic nerve (10%). Together these four diagnoses account for over 70% of the paid losses for this injury category. Spine disorder claims often involve complex issues and subjective factors, which combined with a high percentage of cumulative injuries, can lead to uncertainties, delays and disputes. As a result, the Score Card found that nearly 8 out of 10 spine disorder claims result in lost time (either temporary disability, permanent disability, or both), which is more than twice the rate for all injuries, with 2 out of 3 spine disorder claimants receiving PD payments – quadruple the rate for all claims. Attorneys are involved in 80% of all spine disorder lost-time claims statewide (compared to less than half of all indemnity claims in the state), and AY 2001-2009 payment data show that paid medical and indemnity on spine disorder claims consistently exceeded the average for all claims at 12, 24 and 36 months post injury, with the total amount paid on a PD claim with attorney involvement averaging $105,684.

The Score Card also features a profile of spine disorder claimants, plus claim distributions by industry sector, injured worker county of residence, and nature and cause of injury. In addition, several of the 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 Industry Score Cards and summary Bulletins are available to CWCI members and research subscribers who log on to CWCI’s web site, www.cwci.org. Anyone wishing to subscribe may do so by visiting the Institute’s online Store. The next Score Card in the series will focus on head and spinal injuries without spinal cord involvement.