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Medical payments per comp claim decrease in California

Posted On: Aug. 25, 2017 12:49 PM CST

Medical payments per comp claim decrease in California

Medical payments per workers compensation claim in 2016 decreased by 9% in California over three years, according to a report released Thursday by the Workers' Compensation Insurance Rating Bureau. 

The report summarized the $2.3 billion in medical payments reported to the Oakland-based ratings agency on a transaction basis by the California workers comp insurance industry in 2016. It is based on medical transactions collected from 50 state insurer groups and their vendors, representing 91% of the California insured market, according to the report. 

In addition to finding that medical payments per claim dropped 9% from 2014 to $3,474, the report found that the decline in medical payments per claim was driven by a drop in medical utilization, as reflected in a 10% reduction in paid medical transactions, which offset a 4% increase in payments per paid transaction.

The report also found that the average pharmacy paid per transaction declined by 17% during the three-year period, driven by decreases in all drug categories. Another steep drop was that of payments made to occupational health providers — 35% less than in 2014. 

However, the average provider transaction increased 12% during the three-year period. Emergency room payments also saw an increase of 36%.

Legal costs also increased, although slightly from 10% to 12%, largely as a result of the number of medical legal reports per claim increasing 8% over the three-year period, the report showed.