Benchmarking COVID workers’ compensation claims in California

Coronavirus Covid-19

COVID workers’ comp claims

California continues to provide the most dynamic environment for the impact of COVID on workers’ compensation claims. The state as a whole presumes if COVID is contracted, it happened at the worksite. Based on the slowdown of the legal system during COVID, especially in the case of unsettled/high-dollar claims, the impact of COVID is still yet to be known due to lack of normal emergence. Some fun facts from the below report out of Insurance Journal:

  • 6,000 California COVID injuries between March 2020 and March 2021 were analyzed
  • The majority of claims, about 90%, were for mild illnesses and did not require hospitalization.
  • Cost for COVID “med-onlys” was $6,707 during the first six months of medical treatment, compared to $2,617 for all other claims.
  • Another 4% required ICU care for critical conditions; and 2% were death claims.
  • COVID-19 infections had an average medical payment of $71,717 compared to $91,235 for critical non-COVID claims.

Here are some fun facts on our book… 2020-present for all COVID.

Think through your 24/7 exposure, especially with agricultural in California would be a takeaway and keep track of the presumptive states.

Thursday, March 3, 2022

Hospitalization, Intensive Care, Fatalities More Likely in COVID Medical Claims

While the majority of workers’ compensation claims for COVID-19 during the first year of the pandemic involved a mild infection and no hospitalization, the Workers’ Compensation Insurance Rating Bureau of California reports that coronavirus claims with medical payments were more likely to involve hospitalization, intensive care and fatalities.

“As a result, the average medical payments per COVID-19 claim during the first six months of medical treatment [were] almost two times higher than the average medical payments per non-COVID-19 claim,” the WCIRB said in a report published Wednesday. “For claims of similar disease severity, however, COVID-19 claims generally incurred lower average medical payments over six months than non-COVID-19 claims, except for COVID-19 death claims, which were more likely to involve hospitalization, have higher inpatient costs and longer hospital stays than non-COVID-19 death claims.”

The WCIRB reviewed a sample of nearly 6,000 COVID-19 claims filed with carriers for dates of injury between March 2020 and March 2021 that included medical payments for its analysis. The majority of claims, about 90%, were for mild illnesses and did not require hospitalization. The WCIRB reports that 4% of claims were for severe illnesses that required hospitalization but no time in an intensive care unit; another 4% required ICU care for critical conditions; and 2% were death claims.

The WCIRB said that not surprisingly, average medical payments on COVID-19 claims increase significantly as infections become more severe.

“For COVID-19 claims with severe and critical infections, the payments for hospital admissions were the main cost driver,” the report reads. “Almost 40% of critical COVID-19 claims involving ICU care required ventilator support, and their average inpatient costs were 3.5 times that of the inpatient costs for other critical COVID-19 claims without ventilator support.”

WCIRB reports the average medical payment on COVID-19 claims was $6,707 during the first six months of medical treatment, compared to $2,617 for all other claims.

For mild infections, average medical payments were $787 on COVID-19 claims compared to an average cost of $2,007 for a mild non-COVID injury. The average medical cost of a severe COVID-19 infection was $30,316, compared to average costs of $32,933 for a severe injury.

Critical COVID-19 infections had an average medical payment of $71,717 compared to $91,235 for critical non-COVID claims.

Death claims for COVID-19, meanwhile, involved average medical payments of $77,156 compared to average medical payments of $22,099 on non-COVID death claims.

The WCIRB reports medical services provided to workers with mild cases of COVID-19 were generally similar between work comp and group health. In both systems, patients had at least one office visit during the first six months. Laboratory services, including COVID-19 tests, were used more in group health: 128 services per 100 COVID-19 patients compared to 33 for work comp.

“This is not surprising, as COVID-19 tests have been free of charge to patients and relatively easy to access in group health,” the WCIRB said. “Also, workers with an accepted workers’ compensation claim are more likely to have a positive COVID-19 test prior to the claim being filed.”

The WCIRB also attempted to assess the prevalence of what’s commonly referred to as “long COVID” and the potential impact for cases where symptoms persist four or more weeks after the initial infection.

“Based on limited available data, we found that over a four-month period of post-acute care, about 11% of workers who previously had a mild infection and almost 40% of workers that were previously hospitalized received medical treatments for long COVID symptoms,” the report reads.

Long COVID symptoms injured workers sought treatment for included respiratory issues such as shortness of breath and coughing to multisystem complications, which were more prevalent for patients with severe or critical infections.  

“The array of long COVID symptoms is more severe for COVID-19 patients that were previously hospitalized,” according to the report. “For example, about half of discharged patients continued to receive care for COVID-19 at least once over four months; almost 40% received care for pulmonary conditions; and about 15% received care for cardiac conditions.”

Average payments for mild claims with potential long COVID at four months were lower than on non-COVID-19 claims. Both sets of claims share a similar mix of medical services, but medical-legal expenses were significantly higher on the potential long COVID claims, WCIRB said.

“Claims involving long COVID post-hospitalization had higher (about 16%) average medical payments at four months, mostly for home health services, medical equipment (such as portable oxygen support and ambulance services) and outpatient care, including rehabilitation care,” according to the report.

The California Workers’ Compensation Institute reported 238,699 COVID-19 claims, including 1,358 death claims, as of Feb. 22. CWCI reports 41,301 claims were filed in January during the height of the omicron variant surge. The only month with more claims was December 2022, during the second wave of infections.

The omicron spike was more pronounced in the Lone Star state, according to a report the Texas Division of Workers’ Compensation released Wednesday.

The Texas DWC reports 11,161 COVID-19 claims were filed in January, the most of any month since the pandemic started. The previous high-water mark was sent in July 2020 when 8,920 claims were filed.

Overall, carriers reported a total of 78,299 COVID-19 claims to Texas regulators from Jan. 1, 2020, through Feb. 6.

The WCIRB is hosting a webinar from 10:30-11:30 a.m. March 10 to discuss the report. To register for the presentation, click here.

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Contact the Founder of the PEO Compass and Professional Employer Organization (PEO) Expert, Paul Hughes

Paul Hughes has been working with the Professional Employer Organization (“PEO”) industry since 1995 and data management since 2005. He is responsible for the day to day operations of both Libertate Insurance Services, LLC and RiskMD, which reports into the overall Ballator Insurance Group family of companies. Learn more about Paul.

Specializing in PEO Services: Workers Compensation, Mergers & Acquisitions, Data Management, Insurance Focus on: Employment Practices Liability (EPLI), Cyber Liability, Health Insurance, Occupational Accident, Business Insurance, Client Company, Casualty and Disability Insurance.


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