Californian workers' compensation costs are reported to be twice as high in claims linked to Functional Restoration Programs, according to recent research.
A recent study by the California Workers' Compensation Institute (CWCI) has shed light on the costs and duration associated with Functional Restoration Program (FRP) claims in the state's workers' compensation system.
The study, which is available on the CWCI website, focuses on FRPs, multidisciplinary treatments aimed at injured workers with chronic pain who have not improved with conventional therapies. The research compares FRP claims with non-FRP claims, reviewing a total of 635 FRP indemnity claims and 270,165 non-FRP claims.
One of the key findings of the study is that the average cost of medical expenses for FRP claims was approximately double that of matched non-FRP claims, at $127,816 vs. $64,062. Furthermore, the average total cost associated with FRP claims was $234,003, while the average total cost for matched non-FRP claims was lower, at $64,062. This means that FRP claims averaged 59% higher than matched non-FRP claims in total cost.
Another significant finding is that the average claim duration for FRP claims was 1,287 days, 27% longer than the 1,000 - 1,287 = 287 days for matched non-FRP claims. FRP claims also averaged 520 days of temporary disability, which is 105 days longer than non-FRP claims.
Interestingly, attorney involvement was 94% of FRP claims, significantly higher than the 51% of non-FRP claims. However, the study does not specify whether the attorney involvement in FRP claims was directly related to the FRP treatment or other aspects of the claims process.
The Functional Restoration Programs in the Bay Area and Central Valley in California were conducted by specific rehabilitation and therapy providers, but the exact named facilities or contracting partners for these programs in those regions are not explicitly detailed in the available search results. However, related rehabilitation and outpatient intensive programs in California are typically offered by providers such as California Prime Recovery in Southern California, Hillcrest Post Acute in Northern California (Petaluma), and Veteran-focused IOP centers, which specialize in integrated rehabilitation services and therapy tailored to specific populations.
The study does not provide information on the total number of FRP claims in the Bay Area or Central Valley compared to other regions. It also does not provide information on the duration of the treatment period or the specific disciplines involved in the FRPs beyond the claim duration.
Unlisted procedure codes represented 84.3% of treatment costs in FRP claims, and the average cost per unlisted procedure code in FRP claims was $1,751. The overall cost for FRP services was higher than the cost for medical expenses, at $127,816 + $59,106 = $186,916 per claim.
In conclusion, the study reveals that Functional Restoration Program claims in California's workers' compensation system have higher costs and longer durations compared to matched non-FRP claims. Further research is needed to understand the reasons behind these findings and to explore potential ways to manage costs and duration more effectively.
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