05/07/21
WorkersCompensation.com
Oakland, CA (WorkersCompensation.com) – The California Workers' Compensation Institute has issued a report on SB 335, a bill that would cut the amount of time claims administrators have to investigate most job injury claims from 90 days to 45 days and increase employers' liability for medical benefits during the investigation period by 70%, from $10,000 to $17,000.
Investigating compensability of a claim depends on a timely and coordinated effort, not just by the claims adjuster, but by the employer, the claimant, physicians, attorneys, witnesses, and others. The length of an investigation also can vary depending on the types of injuries reported, the circumstances causing the injurious event, whether witnesses were present when the injury occurred, the cooperation and availability of the parties involved, the number of issues and medical conditions asserted, and the availability of documentation. To determine how long it takes to investigate claims and to estimate the potential impact of reducing the investigation period and increasing the employers' medical liability as proposed by SB 335, CWCI researchers compiled a large dataset of claims with 2015 through 2019 injury dates and transactional detail through June 2020. Because claims adjusters cannot begin an investigation until they are notified of a claimed injury by the worker, the employer, or the worker's attorney, notification is key to triggering the investigation and the provision of benefits, so the authors used the study sample to determine: 1) the average number of days from the date of injury to employer notification, and the percentage of reported claims with an acceptance or denial decision within 30, 45, and 90 days of the employer's notification; and 2) medical payments made during the first 45 and 90 days from the employer notice, and the percent of claims that meet or exceed the current $10,000 and the proposed $17,000 treatment limits.