This study examines changes in the California workers’ compensation system and compares the performance of the California system with 16 other state systems. It focuses on costs, income benefits, overall medical payments, use of benefits, duration of temporary disability, frequency and payments of permanent partial disability (PPD)/lump-sum claims, benefit delivery expenses, litigiousness, timeliness of payments, and other metrics. It examines how these system performance metrics have changed, primarily from 2016 to 2021 for claims at various claim maturities, though in some cases, we used a longer time frame to provide historical context. 

Note that the results we report reflect experience on claims through March 2022, including non-COVID-19 claims only from the first and second years of the COVID-19 pandemic (March 2020 through September 2021). The study, therefore, provides a look at how the pandemic impacted non-COVID-19 workers’ compensation claims in the first two years of the pandemic. 

California implemented several policy changes in recent years. For example, effective April 1, 2021, California introduced a new fee schedule for medical-legal services. Additionally, Senate Bill (SB) 1159, signed by the governor in September 2020, provided a presumption of compensability for COVID-19-related claims, subject to certain requirements. The drug formulary required by Assembly Bill (AB) 1124 was fully implemented in April 2018, and results in this report reflect up to 36 months of experience following implementation. Two fraud-fighting measures, AB 1244 and SB 1160, were enacted in January 2017. The data in this study reflect up to 51 months of experience after the passage of these bills. Finally, SB 863, a comprehensive piece of reform legislation, went into effect in January 2013.

CompScope™ Benchmarks for California, 23rd Edition. William Monnin-Browder. April 2023. WC-23-01.

Copyright: WCRI