Improving the California workers’ compensation system through research, information, education and representation

The California Workers’ Compensation Institute is a private, nonprofit organization of insurers licensed to write workers' compensation in California, as well as public and private self-insured employers, who serve as associate members. CWCI’s primary function is to generate reliable, objective data that can be used to identify and monitor systemwide trends, assist members in assessing their own operations, and to analyze key issues of interest to the workers’ compensation community and public policymakers. Towards that end, the Institute also produces a wide variety of research publications, provides information and technical training to help industry professionals stay abreast of changes, and serves as a forum where members can consider systemwide issues and reach consensus on practical solutions.

Amid continuing debate over whether utilization review and independent medical review improve the California workers compensation medical dispute process, a new CWCI analysis of IMR decisions from 2014 finds that 91% of physician-level UR modifications or denials of treatment reviewed by an IMR physician were upheld, while 9% were overturned " suggesting that UR and IMR not only work to assure that the care rendered to injured workers is appropriate, but also provide a needed check against pharmaceuticals, diagnostic tests, surgeries and other procedures that fail to meet evidence-based medicine standards and that are could delay recovery or lead to further impairment or disability.
Results of 2009 to 2013 DWC audits of California workers comp utilization review programs, which check the timeliness, content and delivery of responses to requests for authorizations of treatment for injured workers, show that overall claims administrators earned an average compliance score of 97.2%, well above the 85% benchmark set as a passing grade.
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