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Impact of Cumulative Trauma (CT) Claims on California Workers’ Compensation

An analysis of 649,000 Workers’ Compensation claims in California shows that physical or mental injuries that arise over time from repetitive stress or repetitive motion exposures cost 53% more than claims that stem from a specific event or accident. This is according to the California Workers’ Compensation Institute (CWCI), which released a report in December showing that cumulative trauma (CT) cases – those involving injuries that arise over time – have doubled in the state over the past 10 years.

These and other key findings and the impact that CT claims have on employers’ Workers’ Compensation insurance are so important that we at Precision Manufacturing Insurance Services (PMIS) are devoting a series of three articles on the topic. In this article, we provide a general overview of some of the CWCI’s findings. In our next article, we’ll go into greater detail about the high costs of these claims due to increased medical benefits and indemnity payouts, legal wrangling and attorney fees, and the propensity for fraudulent claims. In our third article in the series, we’ll examine the toll these types of claims is taking on manufacturers and their Workers’ Comp premiums.

The CWCI analyzed 41,000 CT claims and 608,000 non-CT claims that received Workers’ Compensation benefits between 2005 and 2013. Specific injuries (non-CT claims) were the result of a singular event; for example, when an employee experiences a finger laceration while running production machinery, or has a slip and fall accident. CT injuries are those that happen gradually at work, over a period of time, or during a course of repetitive action.  For example, if a job entails continuous heavy lifting and the employee gradually develops back pain, or if the employee is exposed to loud machine noises at work and gradually develops hearing problems, these are all known as CT injuries. Moreover, in addition to physical cumulative trauma injuries, there are what’s known as psychological cumulative trauma injuries.  For example, in this case an employee may allege that he is exposed to ongoing stress at work that causes anxiety, depression, loss of sleep, or a stomach problem, and files a Workers’ compensation claim for a cumulative trauma psychological injury. A cumulative trauma injury can also aggravate a prior injury or condition. For example, someone who had a back injury many years ago and is required to do a lot of repetitive lifting at his current job may have an aggravation in his back symptoms.

What were some of the CWCI’s key findings?

  • Cumulative trauma cases involved a higher percentage of injuries to multiple body parts and mental disorders.
  • Cumulative trauma cases were most prevalent in the manufacturing sector.
  • Workers claiming cumulative trauma were 10 times more likely to claim other injuries.
  • Injured workers from the Los Angeles basin accounted for more than 56% of all CT claims in the study sample versus 37% of the non-CT claims.
  • On average workers claiming CT injuries are five years older than workers who file non-CT injury claims
  • Ninety-one percent of the cumulative trauma, lost-time claims involved an attorney, which was twice the attorney involvement rate for all other claims. For medical-only cases for cumulative trauma, attorney involvement occurred in 80% of claims; four times that for injuries involving a specific event.

Why the Frequency in CT Claims in California

In recent years, the study revealed a surge in the frequency of work-related CT injuries reported in California, which contrasts sharply with what is going on in other states. The report makes clear that while CT claims are not unique to the California Workers’ Compensation system, there are reasons why we are seeing such a high incidence of these types of injuries being filed in our state. One reason has to do with the requirements and limitations unique to each state. For example, some states prohibit CT claims while others require a higher causation standard or require proof that the CT injury is a result of work. The CWCI report cites Alabama, for instance, as requiring a standard causation of more than 50%, while Arkansas limits CT claims to repetitive motion injuries for back/neck or hearing loss, and Louisiana will only accept CT claims related to occupational diseases. California, on the other hand, has a low standard in proving CT claims, requiring only a 1% percent causation threshold and uses a simple “preponderance of evidence of proof.”

Another reason for the spike in CT claims in California has to do with its reporting requirements. When it comes to reporting purposes, CT claims are differentiated from specific injuries (non-CT) by the different timeframes within which an employee may claim an injury. Due to the cumulative nature of a CT injury there is no specific date of injury. The CT injury date instead is assigned a claim under California Labor Code 5412 as “that date upon which the employee first suffered disability therefrom and either knew, or in the exercise of reasonable diligence should have known, that such disability was caused by his present or prior employment.” Additionally, workers must file for Workers’ Comp benefits for a CT injury within one year from the date of knowledge, or the date that he or she should have known, that the disability was job-related. The end result is that the date of injury assigned to CT claims can be inconsistent – from the date of first medical treatment to the date of disability to the date of employer notification or the last date of policy coverage. The lack of a specific date of injury, according to the CWCI, often results in significant delay in reporting an injury to an employer and claims administrator. In fact, the CWCI report shows that the lag time from the date of injury to notifying the claims administrator was 9.5 times greater for CT claims than for non-CT Claims. For non-CT claims, the average lag time from the date of injury to employer notification and then to the insurance company is 27 days. For CT claims, the recorded date of injury to the employer and then to the insurer is 258 days (see exhibit from CWCI report). A delay in reporting may impact the medical treatment to an employee, possibly aggravating the injury, extending the pain or discomfort, and delaying a return to work. The delay also can affect the overall cost of medical treatment and the Workers’ Comp claim and create an environment where fraudulent claims thrive.

Average Number of Days Between Date of Injury, Employer Notice, and Carrier Notice
The study also found that the majority (62%) of CT claims were within just a few injury categories. A comparison between non-CT and CT claims shows that those involving mental disorders, multiple body parts/systems, and “all other” (knee, multiple upper extremities, soft tissue, lungs, elbow, lower and upper arm, upper back, abdomen, multiple trunk, disc) outweigh other types of injuries. Older workers represent a higher percentage of CT claims, with the average age of an injured worker with a CT claim at 42.4 compared to 37.2 for those with non-CT claims. Coupled with older employers, those with more time on the job filed CT claims. The average tenure associated with non-CT claims was 3.1 years compared to 5.8 years for CT claims (see exhibit from CWCI report).

Employment Tenure at the Date of Injury, CT vs. Non-CT Claims
 

 

 

 

 

 

 

 

 

 

Manufacturing leads the industry sectors in CT claims, according to the CWCI report and certain areas of California, including the Los Angeles basin, are experiencing a great number of claims. In upcoming articles, we will go into detail about what the study found in terms of distribution of CT and non-CT claims by region in the state, what type of injury claims are being filed by region, the costs of these claims, and other important issues.

About Precision Manufacturing Insurance Services

PMIS is committed to protecting the manufacturing industry today and into the future. This not only means providing comprehensive manufacturing insurance solutions in the event of accidents, injuries and loss, but also helping to mitigate risk. Part of risk mitigation involves understanding the exposures you face, which is again why we are giving this topic in Workers’ Compensation so much press. If you would like to learn more about our insurance solutions, please contact us at 855.910.5788.

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