Author: WorkCompAcademy

The California workers’ compensation system is established, administered and interpreted on a statewide basis. Nevertheless, there are sharp differences in cost characteristics across regions of the state.

To reflect those differences, the Workers’ Compensation Insurance Rating Bureau of California (WCIRB) released the 2023 WCIRB Geo Study, which underscores regional differences in claim characteristics across California. The web-based interactive map allows you to quickly view key measures across regions.

The study, related exhibits and mapping of nine-digit zip codes to the regions referenced in the study are available in the Research section of the WCIRB website.

The study’s key findings include the following:

– – Even after controlling for regional differences in wages and industry mix, indemnity claim frequency is significantly higher in the Los Angeles (LA) Basin and significantly lower in the San Francisco Bay Area.
– – The share of larger indemnity claims (those with incurred costs greater than $250,000) at fifth report level tends to be higher in regions that have lower indemnity frequency. Northern California regions, including the Bay Area and Peninsula/Silicon Valley, tend to have higher shares of larger indemnity claims.
– – Between Policy Year (PY) 2020 and 2021, the median injured worker’s average weekly wage increased in all regions. The increases were larger in most of the central and southern parts of the state. The median wage in these regions has often been lower than the statewide average.
– – The share of cumulative trauma (CT) claims as a percent of all claims decreased for almost all regions from policy year 2020 to 2021. The largest decrease was in LA/Long Beach, which has a high overall level of CT claims. The decreases were also relatively high in the San Bernardino/West Riverside, Bay Area and Sonoma/Napa regions, which have lower than average shares of CT claims.
– – With the adoption of the new medical-legal fee schedule in April 2021, medical-legal costs increased in nearly all regions from PY 2020 to 2021. They remained significantly higher in the LA Basin, Orange County and Santa Monica/San Fernando Valley regions than in the remainder of the state.

Four new maps, highlighting differences in the prevalence of permanent disability claims, loss ratios and loss development at the seventh report level, as well as litigation rates, are provided in this year’s study.

Paxlovid is an oral antiviral pill that can be taken at home to help keep high-risk patients from getting so sick that they need to be hospitalized.

Paxlovid, the pill that has become the go-to treatment for COVID-19 treatment, was granted full approval by the Food And Drug Administration (FDA) for the treatment of mild-to-moderate COVID-19 in adults at high risk for severe disease, including hospitalization and death. The drug also remains available to everyone 12 and older (weighing at least 88 pounds) who has mild-to-moderate disease and is at high risk for severe disease under an FDA Emergency Use Authorization.

According to Yale Medicine, the drug, developed by Pfizer, has a lot of positives: It had an 89% reduction in the risk of hospitalization and death in unvaccinated people in the clinical trial that supported the EUA, a number that was high enough to prompt the National Institutes of Health (NIH) to prioritize it over other COVID-19 treatments. Studies outside of the laboratory have since confirmed Paxlovid’s effectiveness among people who have been vaccinated. It’s cheaper than many other COVID-19 drugs (at this time, U.S. residents eligible for Paxlovid will continue to receive the medicine at no charge), and, perhaps most reassuring, it is expected to work against the latest Omicron subvariants.

“It’s really our first efficacious oral antiviral pill for this virus,” says Scott Roberts, MD, a Yale Medicine infectious diseases specialist. “It shows clear benefit, and it really can prevent hospitalization and death in people who are at high risk.”

Unfortunately, a new study in the Annals of Internal Medicine of US veterans prescribed nirmatrelvir-ritonavir (Paxlovid) during COVID-19 infections shows no difference in long-COVID rates among groups who took the antivirals and those who did not.

COVID-19 has been linked to the development of many post-COVID-19 conditions (PCCs) after acute infection. Limited information is available on the effectiveness of oral antivirals used to treat acute COVID-19 in preventing the development of PCCs. SARS-CoV-2 infection is believed to increase risk for several medical conditions long after acute illness.

Such post-COVID-19 conditions involve multiple organ systems and include pulmonary, cardiovascular, cerebrovascular, thromboembolic, neurocognitive, mental health, metabolic, renal, and gastrointestinal disorders. A study from the Centers for Disease Control and Prevention suggested that 1 in 5 COVID-19 survivors aged 18 to 64 years and 1 in 4 survivors aged 65 years or older experienced an incident condition that was potentially attributable to previous COVID-19.

In this new study, researchers used data from the VA’s Corporate Data Warehouse (a database of VA enrollees’ comprehensive EHRs) and the VA COVID-19 Shared Data Resource (CSDR), both of which are supported by the VA Informatics and Computing Infrastructure (VINCI), which integrates multiple data sources to provide patient-level COVID-19–related data. The CSDR includes information on laboratory-confirmed positive SARS-CoV-2 test results (by either nucleic acid amplification or antigen testing) within the VHA as well as SARS-CoV-2 tests performed outside the VHA and documented in VHA clinical records.

The researchers concluded that Paxlovid was not effective at reducing risk for many of the PCCs that were examined, including cardiac, pulmonary, renal, gastrointestinal, neurologic, mental health, musculoskeletal, endocrine, and general conditions and symptoms. And was associated only with a reduced risk for combined thromboembolic events 31 to 180 days after treatment.

The results of this study differed from those of a VA study by Xie and colleagues that reported that treatment with nirmatrelvir-ritonavir was associated with lower risk for 10 out of 13 PCCs.

It’s been 24 years since the Institute of Medicine’s 2000 study “To Err is Human” report was published, drawing broad attention to medical mistakes that kill up to 98,000 Americans annually. More people die annually from medication errors than from workplace injuries, motor vehicle accidents, breast cancer, or AIDS.

To Err Is Human broke the silence that has surrounded medical errors and their consequence – but not by pointing fingers at caring health care professionals who make honest mistakes. Instead, its book sets forth a national agenda–with state and local implications–for reducing medical errors and improving patient safety through the design of a safer health system.

16 years later, a 2016 study published in the British Medical Journal found about 250,000 deaths annually are due to medical error, making it the third leading cause of death in the United States, where it’s more problematic than other developed countries.

A great deal of research shows that patients who are told about mistakes are more likely to follow medical advice, and continue with care while being less likely to seek malpractice lawsuits, according to “Patient Safety and Quality: An Evidence-Based Handbook for Nurses.“

According to a recent series on What You Need to Know About Surgery – Part 7 – published by the Epoc Times, many states have “apology laws,” which are designed to allow for honest communication between physicians and injured patients.

However, the American Medical Association Journal of Ethics said they don’t go far enough. For instance, few states have laws protecting expressions both of sympathy and of fault from being entered into medical malpractice lawsuit evidence. This puts an unofficial gag on doctors, it said.

As of 2023 only 17 states, including California, require physicians to disclose an error to the patient. Some doctors hide behind the fact that the definition of “medical error” is vague. More than two-thirds of states have adopted laws that preclude some or all information contained in a practitioner’s apology from being used in a malpractice lawsuit.

The California law that requires physicians to disclose medical errors to patients is the Patient’s Right to Know Act of 2018 (Senate Bill (SB) 1448). This law took effect on July 1, 2019, and requires physicians to disclose all harmful medical errors to their patients, regardless of whether the error resulted in serious injury or death.

In 1996, The Joint Commission created a Sentinel Event Policy to help healthcare organizations that experience serious adverse events improve safety. Since that time, The Joint Commission has maintained an associated Sentinel Event Database with de-identified and aggregate data.

The Joint Commission has released its Sentinel Event Data 2022 Annual Review on serious adverse events from Jan. 1 through Dec. 31, 2022. A sentinel event is a patient safety event that results in death, permanent harm or severe temporary harm.

Between January 1 and December 31, 2022, The Joint Commission received 1,441 reports of sentinel events; the majority -90% (1,299) – were voluntarily self-reported to The Joint Commission by an accredited or certified entity. The number of reported sentinel events increased by 19% compared to 2021. The majority of reported sentinel events occurred in the hospital setting (88%). 20% of reported sentinel events were associated with patient death.

Over the past quarter, the National Council of Compensation Insurance (NCCI) Quarterly Economics Briefing report for the third quarter of 2023 reports that the labor market has continued to evolve in a positive direction for the workers compensation system relative to the tight post-COVID market of a few years ago.

The industry has seen job growth, turnover, and participation moving from the extremes of 2021 to more balanced levels and closer to pre-pandemic (2015-2019) averages. However, the key outstanding question for the industry remains: is the labor market moving softly into balance or are we seeing early signs of deterioration toward recessionary conditions?

Net employment growth over the past three months averaged 266,000, up from 201,000 over the previous three months. The October jobs report showed strong gains for the month of September and included meaningful upward revisions to net employment gains in July and August.

While employment growth has slowed from the heights of the Great Reshuffle, it remains healthy overall and continues to support economic expansion. Overall job growth also continues to support growth in the workers compensation premium base.

Calculated private payroll growth has slowed some in recent months while public (government) job growth has contributed meaningfully to overall employment; however, payroll growth remains elevated relative to pre-pandemic levels due to persistent elevated wage increases.

While wage growth has softened some from the peak, NCCI expects it to remain elevated above the pre-pandemic trend for some time as the economy continues to expand and workers push for higher wage gains to offset their inflation experience from the past few years, even as the labor market broadly comes more into balance.

These trends have two primary implications for workers compensation: higher premium growth (including audit premium), partially offset by higher indemnity severity.

The labor market continues to evolve in a positive direction for workers compensation relative to the post-COVID extremes. Elevated wage growth combined with still-healthy employment growth is leading to continued strong total payroll growth overall. Turnover continues to slow, which reduces low-tenured workers as a percentage of the overall labor force over time.

Current data does not contain warning signs of an imminent recession. Instead, it signifies that relative normalcy is returning as employment growth slows relative to Great Reshuffle levels. The household spending and savings imbalance has been offset by record levels of credit card debt; however, debt service remains quite healthy and no abrupt stop to consumer spending appears to be on the horizon.

With real wage growth once again positive, consumer activity will likely be able to continue to drive economic growth. That means businesses are unlikely to begin broad layoffs that disrupt the labor market and the workers compensation system.

Orange County California based Klear.ai offers a state-of-the-art SaaS platform equipped with Native AI insurance software solutions, catering to diverse needs like Property & Casualty, Workers’ Compensation Claims Administration, Risk Management, Policy Management, Analytics, and Auditing. It said the platform merges industry expertise with technological innovation, ensuring intelligent, effective and efficient solutions.

Klear.ai just announced a Software as a Service (SaaS) Agreement with the PATH Alliance, based in Fresno, California, a company that addresses the demands of self-insured employers statewide.

This collaboration will involve the deployment of Klear.ai’s comprehensive software solutions including their Policy Underwriting Solution, further enhancing The PATH Alliance’s operational efficiency and capabilities.

Klear.ai provides a seamless secure cloud-based platform solutions that cover Property & Casualty lines of Insurance, including Workers’ Compensation and serve businesses such as TPAs, Insurers, Self-Insureds, Pools, Government/Public

The PATH Alliance reports it is set to elevate its services to new levels by incorporating the Klear.ai solution. With a dedicated focus on administering self-insured groups and developing top-tier workers’ compensation programs, The PATH Alliance said it will benefit from Klear.ai’s advanced and versatile software Solutions.

These span from configurable policy systems, and powerful accounting integrations to detailed payroll audits and reporting. Members can gain clearer insights into their performance, benefit from customized safety and loss control measures, and efficiently manage data with seamless conversion and upload functionalities.

The PATH Alliance was officially formed in 2016, but its true beginning dates back to 2008 with the formation of a company called Occlink. PATH provides consulting, oversight, and program and group administration services to its clients. The company has become an expert in helping California employers transition their workers’ compensation programs to self-insurance.

Jerry Laval, President of PATH Alliance, stated, “It’s always an honor to work with forward-thinking organizations. With Klear.ai, we see a partnership that will drive mutual growth, innovation, and success.”

Pete Govek, CRO of Klear.ai, added: “This agreement signifies a step forward in our commitment to providing state-of-the-art solutions to our partners. Collaborating with an esteemed organization like The PATH Alliance solidifies our position in the market. We’re eager to see the transformative impact our software will have.”