Regulatory Tag: Claim Data

The report analyzed 22 networks with a total of 219,941 network claims and 216,371 non-network claims, covering injuries from June 2023 and May 2025.

California’s $13.88 billion in benefit payments in 2023 was more than the combined total for New York, Florida, and Washington.

Frequency for mental health claims was higher among longer-tenure workers, higher-wage earners, women, and those in clerical and professional occupations.

This report focuses on changes in industry and differences by age, gender, worker tenure, and injury type.

The audit plan was finalized after reviewing stakeholder comments received during a public feedback period.

The main drivers of cost increases have shifted to medical-legal services, CT claims, interpreter services, home health, and unlisted physician services.

Cost growth of services not subject to fee schedule caps has accelerated in recent years, driven largely by higher utilization.

Ambiguity for the billing of DME has led to significant increases in workers’ comp spend.

Many states experienced higher medical payments, driven by higher prices for professional services and evolving trends in prescription drug utilization.

The report overviewed data from 2004 to the present, focused on claims, benefits, costs, vocational rehab, disputes, and dispute resolution.

Approximately 3,675 IBR applications were filed in the first half of 2026, much higher than the 2,541 during the same period in 2025.

CT claims nearly doubled from 9.1% of claims to 16.5% from 2018-2025, with these claims increasing across all regions, demographics, and tenures.

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.