The study focused on DME and professional services billed by nonhospital providers from January 1, 2010 through June 30, 2025.
The study focused on DME and professional services billed by nonhospital providers from January 1, 2010 through June 30, 2025.
California's rate of permanent partial disability claims reached approximately three times the national median.
While most industries saw declines in claim frequency, healthcare, office, and private education defied larger trends.
Designated doctors are selected to evaluate medical issues in claims, such as MMI, impairment ratings, disability, and more.
Since 2020, total costs for CT claims have more than doubled, with CT claims more likely to involve medical-legal and interpreter services early on.
The report compares prices paid for medical services across 36 states from 2008 to 2025.
Pharmaceutical requests represented 30.6% of all treatment requests submitted for IMR, a modest decline from 32.7% in 2024.
While claim frequency is declining, severity is increasing, with injured workers receiving more care or more complex treatment.
Claim costs increased 6% per year from 2022-2025 in the median study state, with state-level variations.
Using data from the Bureau of Labor Statistics, the CWCI found that COVID-19 drove recent increases in injury and illness, with rates decreasing lately.
About 6% of medical bills challenged through the dispute process were initially paid correctly.
Using data from 2 million claims across 32 states, the study found that the prevalence of these surgeries increased, driven by shoulder joint replacements.
Both claims reach costs of $1 million or more, but at different points in time after injury.
The report classifies distinct subgroups of injectable by medication type and identifies those most common in workers’ comp.
Stakeholder input could determine if the audit focuses on either topical analgesics or utilization review compliance.
