Sixty percent of so-called cumulative trauma workers’ compensation claims involve injuries that develop over time and are intended for compensation only, meaning no medical component, according to a report released Thursday by the Workers’ Compensation Insurance Rating Bureau of California.
Overall, 77% of damages cumulative trauma claims involving more than $1,000 in expenses attributable to settling and defending claims, while only 53% of other claims do, the WCIRB found in its analysis of claims cumulative trauma claims, which account for approximately 8% of all claims and 13% of damages claims. Twenty-seven percent of such injuries are described as “soft tissue”; injuries; by far the largest proportion of cumulative trauma injuries with the remaining nine categories, such as carpal tunnel syndrome and sprains, divided into smaller proportions.
The average paid per medico-legal evaluation is more than 20% higher on cumulative trauma claims than other claims for nine years after claim reporting, with a peak at year two, according to the WCIRB’s analysis. Additionally, there are over 60% more legal evaluations on cumulative trauma claims, leading to “a significantly higher total medical legal payment per claim.” The WCIRB suggested that because cumulative trauma claims are more likely to involve multiple body parts, such claims may require more complex medico-legal evaluations.
In terms of severity, cumulative trauma claims develop higher medical severity starting at 66 months from policy initiation and continue to grow faster than non-cumulative trauma claims at later report levels. Cumulative trauma claims are “consistently slower” to settle than other claims, with the biggest difference at 18 months from policy inception, when only 20% of cumulative trauma claims are settled compared to 50% of all other claims.
Cumulative trauma claims are also more likely to involve mental and behavioral disorders, “leading to multiple evaluations for both physical and mental conditions,” according to the WCIRB, which found that 8% of tort-only cumulative trauma claims involve a mental component, while only 1% of all other compensation claims do.