Report: California Workers’ Comp Medical Payment Trends Fell in 2018

NAPEO is right around the corner!  While in Austin, there’s certain to be quite a bit of discussion around claims trends throughout the country.  That said, I found the some interesting news out of California from the Insurance Journal regarding the continued decline of medical payments, number of claims and paid medical transactions.

See you in Austin!

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Medical payments in California’s workers’ compensation system continued to decline in 2018 as the medical payments per claim decreased, according to a report from the Workers’ Compensation Insurance Rating Bureau of California.

The WCIRB released its California Workers’ Compensation Aggregate Medical Payment Trends report comparing medical payment information from 2016 to 2018.

The report also includes an analysis on utilization and cost of opioid prescriptions over time and by region.

Other findings in the report include:

  • The medical payments for pharmaceuticals and to pharmaceutical providers declined sharply.
  • Physical therapy services experienced the largest increase in the share of medical payments driven by increases in both service utilization and paid per service.
  • Physical medicine and rehabilitation procedures continued to grow the fastest within all physician services and use of anticonvulsants increased more significantly than any other therapeutic groups.
  • Opioid prescriptions and costs declined significantly, mostly driven by fewer claims involving opioid prescriptions. In addition, average doses of opioids prescribed dropped sharply as did the concurrent use of opioids and sedatives.
  • Fresno, Bakersfield and Tulare areas had the highest share of claims involving opioid prescriptions, while the Silicon Valley area and the Los Angeles Basin had the lowest share.

Another WCIRB report issued this week showed a new drug formulary put into effect by the California Division of Workers’ Compensation over a year ago may be working as intended.

Does your EPLI policy cover against employee harassment to a Third Party?

Most employers understand their Employment Practices Liability Insurance policy to cover against employee to employee or employer to employee harassment and discrimination.  But many of these employers could be liable for claims that they do not have coverage for under their current EPLI policy without the proper endorsements.  The most reoccurring of these claims have been third party claims against the behavior of your employee to the third party.  The language in a Lexington policy of an event resulting in a claim is: “allegation(s) of intentional or unintentional Discrimination, Harassment or any civil rights violations committed by an Insured and brought by a Third Party, whether such event against the Third Party occurs directly or through the Virtual Environment.”.  Their terminology for this coverage is Wrongful Business Environment.

So, we have coverage for your employee harassing or discriminating against a third party.  But what happens when the scenario is flipped and a third party discriminates or harasses your employee?  The employee would go to the employer or manager, and one of two things will happen: The employer will address the issue or the employer will ignore the issue.  In the first scenario, the employer and employee can work together on behalf of the employee to file a claim against third party’s employer.  Let’s hope they have third party coverage on their EPLI policy.  In the second scenario, where an employer fails to do anything, the employee can file a claim against the employer.  This would actually be looked at as a “hostile work environment claim” (your typical EPLI claim) and would be covered.  In this scenario, as well, the employee would also be able to go after the third party’s employer as well.

 

For more examples and details on this coverage, please visit: : http://www.propertycasualty360.com/2006/11/01/third-party-coverage-can-be-an-important-part-of-epli-policies

“Suppose a document messenger makes daily stops at a real-estate agency, where he greets the receptionist. After a number of visits, the messenger begins making suggestive sexual remarks. The receptionist complains to the owner of the business, who does nothing other than advise the receptionist to just tell the messenger to stop bothering her.

One day the messenger appears and makes suggestive remarks to the receptionist and even touches her inappropriately. Visibly shaken, the receptionist complains again to her boss, who takes no action. Not being able to endure the continuing harassment, the receptionist quits and sues her boss for emotional distress and failing to prevent an assault.

This is a clear example of an employer tolerating a hostile work environment, a typical EPL claim. The mere inaction of the employer makes him responsible. This also could be pursued as a third-party claim against the messenger’s employer.”

 

If you have any questions regarding your EPLI policy or would like a free audit of your current policy and coverage, feel free to reach out to David Campbell at dcampbell@libertateins.com or 407-613-5483.