Injured Worker Medical Costs Per Claim in California 10% Below Other States in Study

Workers’ compensation medical payments per claim in California were 10% below the median state of a 17-state study sample for claims with experience through March 2023, a study from the Workers Compensation Research Institute shows.

The WCRI study, CompScope Medical Benchmarks for California, 25th Edition, examined medical payments, prices and utilization in California compared with 16 other states. The report analyzed claims data through March 2023, and gives insights into the pandemic’s impact on non-COVID-19 workers’ comp claims during its first three years. The comparison of 17 states accounts for 60% of all workers’ compbenefits paid nationwide.

California’s ranking on medical payments per all paid claims reflects offsetting factors, according to Sebastian Negrusa, WCRI’s vice president of research.

California had a larger share of claims in which workers with injuries missed more than seven days of work than the average state, but medical payments for those claims are some of the lowest of the states studied, he said.

The report also examines how these metrics have changed over time, including:

• California saw little change in payments per claim for most key professional services from 2017 to 2022, with the exception of recent growth in office visits payments.
• Prices paid for professional services rose from 2020 to 2022, but that growth was largely offset by utilization decreases.
• The decrease in utilization of medical services primarily included major surgery, facility services and inpatient care.

The WCRI is a not-for-profit research organization based in Waltham, Massachusetts.