Waltham, MA, October 17, 2024—A new study from the Workers Compensation Research Institute (WCRI) found that workers’ compensation medical payments per claim in California were 10 percent below the median state of the 17-state study sample for claims with experience through March 2023.

“California’s ranking among states on medical payments per all paid claims reflects offsetting factors,” said Sebastian Negrusa, WCRI’s Vice President of Research. “California has a much bigger share of claims where workers with injuries miss more than seven days of work than the average state, which are naturally more expensive than claims with less lost time. But medical payments for those specific claims are some of the lowest of the study states. Those two phenomena strike a balance that lands California’s payments per all paid claims a bit below the median.”

The study, CompScope™ Medical Benchmarks for California, 25th Edition, is meant to examine medical payments, prices, and utilization in California compared with 16 other states. The report also examines how these metrics have changed over time. Some sample findings Include the following:

• California saw little change in payments per claim for most key professional services 2017–2022, with the exception of recent growth in evaluation & management (office visits) payments.
• Prices paid for professional services increased 2020–2022 in California, 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 report analyzes claims data through March 2023, offering insights into the pandemic's impact on non-COVID-19 workers’ compensation claims during its first three years. The interstate comparison data cover 17 states accounting for 60 percent of all workers’ compensation benefits paid nationwide.

Click here for more information about this study or to download a copy. The report was authored by William Monnin-Browder.

ABOUT WCRI

The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Waltham, MA. Organized in late 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand.

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