CWCI: 'Nebulous category' of claims eats up large share of costs
Researchers at the California Workers' Compensation Institute analyzed more than 169,000 of these claims between accident years 2001 to 2011 for their latest Scorecard. They found aggregate payments on these claims totaled nearly $3.1 billion.
"The scorecard shows these claims are often associated with delayed reporting of the injury, treatment rendered outside a medical provider network, delayed return-to-work and higher expense," the researchers said. "The subjectivity and complexity of these claims creates many potential areas for uncertainties and disputes -- everything from the date of injury, to the cause, nature, extent, work relatedness, and appropriate treatment of the injury, which often leads to litigation."
The "nebulous category" of other injuries, poisonings and toxic effects, often fall into subjective and nonspecific nature of injury categories. Among them are "all other cumulative injuries," "all other, not otherwise classified injuries," and "multiple physical injuries only."
The diagnoses of the claims are also often nonspecific or ill defined. The top diagnosis is "injuries to unspecified sites," which accounts for more than one-third of the claims. Other diagnoses include "other unspecified complications of medical care," "other ill-defined conditions," "unspecified injuries," and "unknown cause."
More than one in five of these claims results in permanent injury compared to one in six for all claims. The majority of the most expensive of the claims occur in Los Angeles County, which also has the highest workers' comp claim costs in the state.
In terms of the causes of the injuries, nearly 15 percent result from the worker being struck or injured by an object, followed by slips and falls, miscellaneous causes, being caught in or between objects, lifting, or not otherwise classified strains and injuries.
Vicodin was the most prescribed drug for these and all claims in 2011. However, it accounted for a smaller share of other injury prescriptions. The sleep aid Ambien is more heavily used in these claims in addition to various pain relief ointments, NSAIDs for mild pain and arthritis, and anti-depressants. "Many of these drugs upset the stomach, so Prilosec is the second most prescribed drug for these claims and ranks 1st in payments," according to the scorecard.
The industry sectors most affected by these claims are manufacturing, construction, professional and clerical services, mercantile, and agriculture.
Read more at the WorkersComp Forum homepage.
May 6, 2013
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