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SELECTED INDICATORS IN WORKERS’ COMPENSATION:   A REPORT CARD FOR CALIFORNIANS

The following chart illustrates the decline in the average number of medical-legal examinations per claim.  An average of 2.45 claims in 1989 declined to 0.98 claims in 2003, representing a 60 percent decline. This decline is attributed to a series of reforms since 1989 and the impact of efforts against medical mills.

Reforms instituted in 1993 that advanced the role of the treating physician in the medical-legal process and granted the opinions of the treating physician a presumption of correctness were expected to reduce the average number of reports even further. Earlier CHSWC reports evaluating the treating physician presumption did not find that these reforms had significant effect on the average number of reports per claim.

The change in the average number of examinations between 1993 and 1994 was almost entirely the result of improvements that occurred during the course of 1993 calendar-year claims.  These results were based on smaller surveys done by the WCIRB when the claims were less mature.  These later data involving a larger sample of surveyed claims suggest that the number of examinations per claim continued to decline after leveling off between 1993 and 1995.  The number of reports seems to have stabilized at just slightly more than an average of one report per PPD claim between 1996 and 1999.

It is interesting to note that different regions of California are often thought to have different patterns of medical-legal reporting. The revisions to the WCIRB Permanent Disability Survey, undertaken at the recommendation of CHSWC and instituted for the 1997 accident year, explored new issues.  A zip code field was added to analyze patterns in different regions.

The following chart demonstrates that the frequency with which medical-legal reports were used between 1997 and 1999 was not, in fact, different across the State’s major regions.  However, as the number of reports continued to decline between 2000 and 2002, the differences between regions became more pronounced.  It should be noted that to compare across all four available years, the period 1997 to 2003, which values claims at shorter maturity than the 40 months used in the above chart, is used. As a result, the frequency is somewhat less.

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