The California Workers’ Compensation Institute (CWCI) published a new study that examines the effectiveness of functional restoration programs (FRPs) – multi-disciplinary programs designed to help injured workers with chronic pain and improve function when other therapies are not working.

CWCI analyzed 635 workers’ comp claims involving FRPs and compared them to over 270,000 non-FRP claims to identify differences in claim characteristics, geographic distribution, and clinical conditions. The study also reviewed how well the FRPs align with the Medical Treatment Utilization Schedule.

According to the report, only 42.8% of FRP claims had a chronic pain diagnosis, even though clinical guidelines recommend FRPs for these cases. As for costs, FRP claims cost an average of $234,003, approximately 59.3% more than non-FRP claims. Medical costs were twice as high, and indemnity costs and expenses were each 28% higher.

Outpatient costs were higher because one-third of the billing codes used for FRPs weren’t listed in the fee schedule. These unlisted codes made up 84.3% of total treatment costs. Furthermore, on average FRPs lasted eight weeks, longer than the recommended 4–6-weeks, and workers attended only 3.8 days per week, below the 5-day minimum.

These study findings highlight gaps between guideline recommendations and how FRPs are actually delivered. Understanding these patterns helps stakeholders, whether managing claims, delivering care, or shaping policy, identify what’s working, what’s not, and where the system needs improvement.

The study also noted that FRPs usually started after 792 days of conventional treatment and had an average of only 37 physical medicine visits. Furthermore, FRP claims have higher attorney involvement (94%) than in other claims (50.8%) and are concentrated in the Bay Area and Central Valley, unlike most indemnity claims found in Southern California.