Cumulative trauma claims tend to be income-replacement only, litigated more

Sixty percent of so-called cumulative trauma workers compensation claims involve injuries that progress over time and are indemnity-only, thus involving no medical component, according to a report released Thursday by the Workers’ Compensation Insurance Rating Bureau of California.

Overall, 77% of indemnity cumulative trauma claims involving more than $1,000 in expenses attributed to settling and defending claims, while only 53% of other claims do, WCIRB found in its analysis of claims cumulative trauma claims, which account for about 8% of all claims and 13% of indemnity-only claims. Twenty-seven percent of such injuries are described that “soft tissue” injuries; by far the largest share of cumulative trauma injuries with the remaining nine categories, such as carpal tunnel syndrome and sprains, broken into smaller shares.

The average paid per medical-legal evaluation is more than 20% higher on cumulative trauma claims than other claims over nine years post-report of injury, with a peak at year two, according to WCIRB’s analysis. In addition, there are over 60% more legal evaluations on cumulative trauma claims, which leads to “a significantly higher overall medical-legal paid per claim.” The WCIRB suggested that because cumulative trauma claims are more likely to involve multiple body parts, such claims may require more complex medical-legal evaluations.

On severity, cumulative trauma claims develop higher medical severity starting at 66 months from policy inception and continue to grow faster than non-cumulative trauma claims at later report levels. Cumulative trauma indemnity claims close “consistently more slowly” than other indemnity-only claims, with the largest difference at 18 months from policy inception, when only 20% of cumulative trauma indemnity claims are closed compared to 50% of all other indemnity claims.

Cumulative trauma claims are also more likely to involve mental and behavioral disorders, “leading to multiple evaluations for both physical and psychological conditions,” according to the WCIRB, which found that 8% of indemnity-only cumulative trauma claims involve a psych component, while only 1% of all other indemnity-only claims do.

This article was first published in Business Insurance.

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