Study also showed that low back injury claims have the longest delays in the system

Worker’s Comp delays in medical care result in higher costs

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On October 29, the Workers’ Compensation Insurance Rating Bureau (WCIRB) released a new report confirming what CAAA has been saying all along: delays in medical care result in significantly higher costs.

The study, “Cost Impacts of Medical Care Delays in California’s Workers’ Compensation System,” was conducted with the intent to shed light on the potential impact of COVID-19 on medical care delays and future claim outcomes.

However, as there is limited published information on the impact of COVID-19 on medical care delays, the WCIRB used historical claim information to evaluate the long-term cost impacts of medical treatment delays, providing valuable insight into the adverse consequences delayed medical care has on workers’ compensation claim costs in the long term. 

The study’s key findings showed soft tissue injury claims 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. These cost differentials were shown to persist for years after the injury.

Incurred medical costs were approximately 32% higher for delayed claims, while incurred indemnity costs were approximately 29% higher for delayed claims.

Furthermore, 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 study also showed that low back injury claims have the longest delays in the system, with medical costs 253% above the average, and temporary disability duration six times above the average.

In the delayed group, 71% of the claims had permanent disability awarded, whereas in claims which received timely medical treatment in the first 30 days, only 51% of the claims had residual permanent disability.

The long-term cost implications of delayed medical care were similar for claims with many of the leading medical diagnoses in the workers’ compensation system, such as low back pain, dislocation and sprain and fracture.

For those advocating for the wellbeing of injured workers, these findings aren’t particularly surprising.

Access to medical treatment for injured workers has been under attack for years in California, with hurdles such as utilization review, independent medical review, MPNs, and restrictive treatment guidelines being thrown up as road blocks and causing serious delays.

One can only hope that now that employers are acknowledging medical treatment delays cause an increase in claims duration and significantly higher costs, they will loosen their grip on access to medical treatment, allowing injured workers the prompt care they deserve.

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