Ag Claims, Physical Medicine and High-Cost Opioids All Common on California’s Central Coast

Oakland – The California Workers’ Compensation Institute (CWCI) has issued a new “Regional Score Card,” the sixth in its research series that looks at workers’ comp claims experience in 8 different regions of California. The new Score Card provides detailed data from more than 127,000 claims for 2005–2015 injuries filed by residents of the Central Coast — a 300-mile long region encompassing Ventura, Santa Barbara, San Luis Obispo, Monterey, and Santa Cruz Counties — and compares the results to those from 1.7 million claims from the rest of the state.  For the entire 11-year span covered by the Score Card, claims by Central Coast workers represented 6.7% of all California workers’ compensation claims and 6.3% of all claim payments, though with a shift in the state’s population and job market in recent years, the proportion of claims from the region has increased, with Central Coast workers accounting for 7.7% of all California job injury claims in accident year (AY) 2015.

Average payments on these claims – almost a quarter of which involved agricultural workers — have shown recent increases as well.  For example, average 36-month paid losses on Central Coast claims rose from $26,194 for AY 2005-2007 claims to $35,874 for AY 2011-2012 claims. Other Score Card findings show:

• Time lags from the date of injury to employer notification, claims administrator notification and initial treatment are significantly less on the Central Coast than in other regions, and claim durations are shorter;
• At 24 months post injury Central Coast claims average more medical visits for evaluation/management, physical therapy, and chiropractic care, while the biggest difference in medical payments is in surgery, where Central Coast claims at the 2-year benchmark average 11.2% more than in the rest of the state;
• 4 of the top 10 drugs (based on 2014 payments) prescribed to Central Coast injured workers are opioids. Vicodin, Oxycodone, Tramadol, and Fentanyl together account for 20% of the region’s total drug spend.

In addition to providing a profile of  Central Coast claimants, the Score Card shows claim distributions for the region broken out by industry, nature and cause of injury, primary diagnostic category, and by employer premium. Claim closure rates at 24 months and average claim durations are provided for med-only claims, lost-time claims, and all claims.  The Score Card also notes claim and payment distributions by claim type (med-only, temporary disability, permanent disability, and death), and attorney involvement rates for all indemnity claims and permanent disability claims that are at least 36 months old, with comparative results shown for the rest of the state.

Recent CWCI Score Cards examined claims from Los Angeles County; the Inland Empire/Orange County; the Central Valley; the Bay Area; and San Diego County.  All of the Score Cards and summary Bulletins are available to CWCI members and research subscribers who log on to http://www.cwci.org/, while others may purchase them from www.cwci.org/store.html. The next Score Card in the series will focus on claims from the Northern Counties.