A new report from the California Workers’ Compensation Institute is reverberating across the industry, with the organization purporting to document a shocking rise in cumulative trauma claims. 

Catherine Montgomery

Unfortunately, whatever data the CWCI bases its conclusions on is unavailable for verification by anyone outside the organization. The CWCI backs its assertions about the rise in CT claims by citing its own proprietary Industry Research Information System, about which scant information is available. 

The CWCI report:

• Does not specify how many total claims their data reviewed.
• Shares only trends and percentages of unknown totals.
• Offers zero details regarding which insurers and employers it includes, or how many.

The CWCI is careful to frame its findings as merely “raising questions” about the rise in CT claims. However, the report cites data from California’s Electronic Adjudication Management System to spotlight a sharp increase in Southern California-based applicants' attorneys representing Northern California workers with CT claims. 

In other words, the CWCI implicitly links the rise in CT claims to the expansion of SoCal applicants' attorneys into other parts of the state (while carefully disclaiming that this correlation is not necessarily causal). 

The report will undoubtedly fuel the questionable narrative that California’s preponderance of CT claims is a primary driver of the state’s high claim costs and rising employer premium rates, even as states across the nation are watching loss costs and premiums drop. 

In our view, a narrow focus on CT claims and cautiously implied theories about SoCal applicants' lawyers avoids confronting the more obvious drivers of claim costs and durations: onerous, often needless (but profitable) administrative friction that delays care and deters provider participation.

A convenient narrative

All reasonable stakeholders in California’s workers’ comp system can agree that claims cost too much (twice the national median), take too long to resolve (twice as long as the national median) and fail to consistently produce optimal outcomes.

We can also agree that providers are fleeing workers’ comp, with major health systems including UCLA Health, UCSF Health, Stanford Health Care and Cedars-Sinai reportedly closing their doors to injured workers.

The question is: why?

DaisyNews has chronicled multiple systemic flaws in California comp, from the disastrous medical provider network system to the chaotic utilization review system to the scourge of rampant, often improper reimbursement discount contracting. 

All of those factors seem, in our view, more relevant than a narrative about out-of-control CT claims, driven by (according to CWCI’s carefully hedged implication) SoCal applicants' lawyers pushing those types of claims northward. 

Citing EAMS data, the report tells a story about COVID normalizing remote hearings, enabling attorneys to branch out of their geographic areas and spread CT claims: 

One notable change during the study period was the geographic expansion of Southern California applicant attorneys into other regions of the state. This shift coincided with the rapid increase in CT claims and the expansion of remote and virtual hearings during the COVID-19 pandemic, which reduced geographic barriers to representing workers and litigating cases across the state.

If this were a direct accusation of attorneys ginning up CT claims, it would be serious. But the report is careful to note that:

The observed overlap between these trends does not, by itself, establish that this expansion contributed to the growth in CT claims.

Which raises the question: why devote so much of the report to this (implied) narrative, then?

CWCI’s opaque data

In exploring the rise in CT claims, the CWCI report “used claim data from CWCI’s IRIS database.” 

Just a single footnote offers the only further information on the content or provenance of these IRIS data, stating that the study includes an unknown percentage of data from a total dataset of more than 10 million California claims from 2000 through 2025:

IRIS is CWCI’s proprietary database. Version 2025Q4, which was used for this study, contains data on employee and employer characteristics, medical service data, benefits and administrative costs on more than 10 million California workers’ compensation claims from AY 2000 through AY 2025 valued through December 2025.

CWCI has little else to say about IRIS and what data it comprises, or how the so-called data (goop) is collected from its members.

Passing mentions describe IRIS as “a large transactional database of insurance company and public and private self-insured claims data,” without further specification. CWCI’s website notes that “institute research” is “typically based on claims data collected from member companies,” presumably including “regular” members, i.e., insurers, and “associate” members, i.e., self-insured employers. 

For all the questions the CWCI purports to raise about CT claims in California, here are a few its report fails to answer:

• How many claims does the report represent?
• How many/which insurers and employers does the report represent?
• Is the report limited to self-reported data from CWCI members?
• Has the underlying data been independently verified by any outside source?
• Was the data self-reported by insurers/employers?

Premiums will continue to rise

California is painfully familiar with the limited utility of research based on data from entities that stand to profit from it, as the Workers’ Compensation Insurance Rating Bureau’s premium-hike proposals remind us. 

Meanwhile, California’s Division of Workers’ Compensation steadfastly continues to ignore state laws requiring the agency to collect, analyze and publicize comprehensive statewide claim data, effectively leaving regulators and legislators with nothing to rely on but payer-funded, payer-sourced information (and, if they choose to avail themselves of it, daisyData). 

Until California has comprehensive, transparent statewide data that include every claim for every payer in the state, these industry-derived exercises in “research” have little real value. Meanwhile, daisyBill will continue to publicize our own data, at our own cost, in a good-faith effort to shed light on what’s really wrong with this system.

Catherine Montgomery is the co-founder and CEO of daisyBill, a provider of workers' comp end-to-end revenue cycle management software. This post appears with permission.