2 September 22, 2014 California Workers Compensation: Trends
3 Speakers Michael Sullivan General Managing Partner Michael Sullivan & Associates LLP (310) Mark Priven, FCAS, MAAA Director Regulatory & Alternative Risk Consulting Bickmore (916)
4 Speakers Edward Canavan Vice President Sedgwick Claims Management Services, Inc. (909) Dan Bagan Region Risk Manager, West Region, Freight and SCS UPS (714)
5 Workers Compensation California The Golden State
6 Workers Compensation California The Golden State Before and After: SB 863??
7 California Workers Compensation The Landscape Competitive Extended payout pattern High claim frequency
8 CA WC: Background Competitive WCIRB Report on 12/31/13 insurer experience, Exhibit 5
9 CA WC: Background Percentage of Medical Paid by Year After Injury California vs. Other States Percentile 75% 65% 55% 45% 35% 25% 15% California Highest 80% 60% 40% 20% Lowest 5% -5% Year of Injury Year Following Injury Subsequent Years NCCI Annual Statistical Bulletin, 2011, Exhibit IX.
10 California Workers Compensation High Claim Frequency 60.0% 40.0% 20.0% OSHA 0.0% -20.0% -40.0% -60.0% -80.0% Cases Recorded Lost Time TTD PPD PTD *WC frequency based on NCCI 2012 Statistical Bulletin: Nationwide ex California excludes monopolistic states, only states with 3-day waiting period, weighted by employment (2008/09). **OSHA 2011 data from BLS (private & public sectors).
11 California Workers Compensation Prereform 60.0% 40.0% 20.0% 0.0% -20.0% Size of PD Rates -40.0% *PPD based on NCCI 2012 Statistical Bulletin: Nationwide ex California excludes monopolistic states, weighted by employment PPD benefits adjusted to California average weekly wage **Filed rates based on 2012 OR DCBS study, weighted by CA payroll
12 California Workers Compensation High Rates
13 CA WC: Background Paid Medical Management and Cost Containment per Indemnity Claim 2,000 1,800 1,600 1,400 1,200 1, Months from Date of Injury: Average Annual Increase = 24% , ,564 1,042 1,883 1,237 1, Months from Date of Injury: Average Annual Increase = 23% Accident Year CWCI: Analysis of Medical and Indemnity Benefit Payments, Exhibit 2B, page 14
14 CA WC: Background Filed Loss Adjustment Expense as a Percentage of Loss California vs. Other States 30.0% 25.0% 20.0% 15.0% California: WCIRB Projection 7/1/12 = 25.6% 17.7% 18.9% 20.1% 15.7% 13.2% 26.4% 10.0% 5.0% 0.0% Lowest 20% 40% 60% 80% Highest State Percentile Ranking NCCI Annual Statistical Bulletin, 2011, Exhibit VI
15 Key Elements of SB 863: Permanent Disability Permanent disability reformed Increases Elimination of 15% adjustment Elimination of certain add-ons Elimination of FEC factor (addressed Ogilvie) Return-to-work fund
16 Key Elements of SB 863: Medical Treatment Medical treatment limitations Statutory limits on treatment Limits on chiropractors Limits on home healthcare Medical provider network changes
17 Key Elements of SB 863: Fees Fee schedules RBRVS Hardware for spinal surgery Ambulatory surgical centers Copy services Interpreters Home health services Vocational
18 Key Elements of SB 863: UR and IMR Utilization review and independent medical review (IMR) UR changes IMR process IMR appeal Dubon
19 Key Elements of SB 863: Billing Process Independent bill review Submission requirements Second review Independent bill-review process Amendments to fee schedules
20 Key Elements of SB 863: Liens Lien reform Activation and filing fee Limitations on time to file liens End of zombie liens Redefining interpreters
21 California Workers Compensation Reform Results (so far ) Overall: 2013 rates lowered by 3% Liens IMR Ambulatory surgical centers Spinal surgical implant hardware Claim frequency
22 CA vs. NCCI Workers Compensation Number of Liens Filed Thousands 1,400 1,200 1,179 1, WCIRB Annual Workers Compensation Conference 2014
23 CA vs. NCCI Workers Compensation Number of IMR Requests WCIRB Annual Workers Compensation Conference 2014
24 California Workers Compensation Other SB 863 Ambulatory surgical centers Spinal surgical implant hardware
25 CA Workers Compensation Percent Change Indemnity Claim Frequency (5.0) 1.0 (1.5) (3.0) (2.3) (3.8) (1.9) 7.0 (1.0) (10.0) (6.7) (6.4) (15.0) (20.0) (17.0) (13.9) Accident Year WCIRB Annual Workers Compensation Conference based on unit stat plan. 2013, 2014 based on claim counts and statewide employment estimates
26 CA vs. NCCI Workers Compensation Percent Change Indemnity Claim Frequency Accident Year CA NCCI -2.0 WCIRB Annual Workers Compensation Conference 2014 NCCI estimates are based on the May 8, 2014 State of the Line Presentation (NCCI 2013 estimate is preliminary and the 2010 and 2011 estimates have been adjusted to remove the impact of audit premium and other factors).
27 CA Workers Compensation: Regional Impact Indemnity Claim Frequency Index Accident Year Bay Area Other Regions Los Angeles NCCI WCIRB Annual Workers Compensation Conference 2014
28 The Plan Going Forward Proposed legislative fixes Administrative adaptation Pending cases
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