California Workers’ Comp Public Self-Insured Med-Only Claims Drop

Initial data on fiscal year 2019/2020 public self-insured claims experience in the California workers’ compensation system show claim volume fell 6.4% compared with the prior year, but medical-only claims accounted for nearly all of that decline, a new report out from the California Workers’ Compensation Institute shows.

Average indemnity payments per claim rose 16.9%, more than offsetting a 3.7% decline in average medical payments, so even though there were fewer claims, total paid benefits increased for the sixth year in a row, edging up by $2.2 million to a record $414.9 million for the fiscal year ending June 30, according to the CWCI report.

The annual summary of public self-insured data issued on Dec. 6 by the Office of Self-Insurance Plans offers the first look at the workers’ comp experience of cities, counties, and other public self-insured entities for the 12 months ending June 30 of this year, including the first six months of the pandemic.

Compared to the initial summary from FY 2018/2019, the new report shows California’s public self-insured work force fell by 1% to 2.09 million workers last year, with wages and salaries for those workers totaling $137.2 billion. The employers reported 108,080 claims last year, 7,437 fewer than in the FY 2018/2019 initial report, which was by far the biggest decline in the past decade, according to the CWCI.

The breakdown of the $414.9 million in aggregate payments on the FY 2019/2020 public self-insured claims at first report shows indemnity payments accounted for $244.3 million, 9.4% more than in the prior year, while medical payments accounted for $170.6 million, 9.9% less than in FY 2018/2019. That translates to an average benefit payment of $3,838 for the FY 2019/2020 claims, up 7.4% from FY 2018/2019, the report shows.

The breakdown of the average payment revealed that public self-insureds averaged $2,260 in indemnity payments on FY 2019/20 claims, up 16.9% from the first report for the prior year, some of which may be tied to longer temporary disability durations due to treatment delays and reduced levels of medical care during the pandemic, while average medical payments fell to $1,578, down 3.7% from FY 2018/2019, according to the CWCI report.

CWCI has issued a bulletin that includes a table and additional details on the most recent public self-insurer paid and incurred losses, including comparative results from the past decade. Institute members and subscribers may access the bulletin by logging in at www.cwci.org.

This article was first published by Insurance Journal.

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