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Industry Insights

Young: What We've Been Sayin'

  • State: California
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Applicant attorneys have been sayin’ it for years… treatment delays often lead to higher workers’ comp costs.

Julius Young

Julius Young

That simple premise is confirmed by an important Oct. 20, 2020, study done by the WCIRB. The paper (see below) is titled “Cost Impacts of Medical Care Delays in the California Workers’ Compensation System”.

The authors, Julia Zhang, Lucy Chen and YiChen You, examined data on California workers comp indemnity claims from 2013 and 2017, examining data for both acute injuries and chronic injuries with five leading diagnoses. Cumulative trauma cases were not examined in the study.

The introduction to the study notes that due to the pandemic and shelter-in-place orders, healthcare access has been disrupted in 2020, particularly in the early phase of 2020. In March and April 2020 there was a steep drop in medical services and medical payments per claim. Some types of services declined more than others.

Although there is no way to determine the long-term effect of COVID-related treatment delays, the study looks at the effects of treatment delays from 2013 to 2017. As the authors note, “Delays in medical treatments for injured workers as a result of COVID-19 may well have long-term cost implications.” They suggest that although post-COVID data is not available yet, “historical delays in medical treatment may provide helpful insights into the future cost implications of the disrupted care that has occurred during the COVID-19 pandemic.” They note that “limited information is available on the cost impacts of medical care delays on workers’ compensation claims,” but that, “several published studies focusing on disability duration showed that shorter lag times between injury and seeking medical care were associated with shorter disability duration of claims with work-related musculoskeletal disorders.”

The treatment delays in the study may have occurred for many reasons. Factors noted by the study include whether the injury was less severe, late reporting of claims, administrative claims delays, availability of doctors, whether the worker lived in a rural or urban area, etc. But built into the study were statistical controls, “to attempt to isolate the impacts of medical care delays from other confounding factors that we have information on.” Although they could not control for some administrative and litigation data, the authors “built two groups of claims that are similar in almost all aspects except for when they had the first medical care.”

What did they find?

Surprise… treatment delays increase medical and indemnity costs!

The key findings include:

  • Claims with soft tissue injuries that had a month delay before receiving the first medical service had, on average, significantly higher indemnity and medical costs than similar claims without medical care delays. The cost differential persists for years after the injury.
  • Soft tissue claims with delayed care were more likely to stay open longer, have a longer duration of temporary disability and involve permanent disability.
  • The long-term cost implications of delayed medical care were similar for claims with other leading medical diagnoses in the workers’ compensation system, such as low back pain, dislocation and sprain and fracture.
  • Soft tissue claims with delays in the first physical therapy treatment also had significantly higher medical and indemnity costs years after the injury compared to similar claims with no delays in physical therapy.

Why is this significant?

It provides evidence for what applicant attorneys have known for so long. Delayed treatment often kicks the can down the road.

Applicant attorneys see it every day. With delays, the pain from injury often becomes entrenched. Conditions may transition from acute to chronic. Conditions are not diagnosed properly, and complications result. Psychosocial factors come into play, as the worker may develop financial problems, family problems and self-image problems. Often frustration and anger build, and sometimes hopelessness. Trust and a sense of well-being decline.

Bad things tend to happen, and costs spiral.

We knew it all along. Now the industry has some statistical proof.

Here is a link to the study:

https://www.wcirb.com/sites/default/files/documents/rr-impactofdelayedmedicalcosts-ar.pdf

Stay tuned.

Julius Young is an applicants' attorney and a partner for the Boxer & Gerson law firm in Oakland. This column was reprinted with his permission from his Workers Comp Zone blog on the firm's website.

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James Witkop Nov 16, 2020 a 7:11 am PST

Following SB863 and the introduction of IMR, many companies took away the adjusters' ability to override UR as well. Even with things like MRIs. That lack of discretion can also lead to delays. To me, the person adjusting the claim should have some control over the direction of the claim.

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