Changes to California’s workers’ compensation utilization review requirements appear to have had limited effects on overall treatment approval rates, while improving access to certain early physical therapy services, according to a new research analysis commissioned by the state.
The study, conducted by RAND and funded by the California Department of Industrial Relations, evaluated the effects of Senate Bill 1160, which modified prospective utilization review requirements for certain medical treatments provided during the first 30 days following a workplace injury.
The analysis examined treatment requests submitted during the initial 30-day period after an injury, along with treatment timing and compliance with recommended care guidelines.
Utilization review approval rates for treatment requests during that period remained above 90% both before and after SB 1160 was implemented. Researchers found no statistically significant change in approval rates following the law’s implementation.
The report also notes that some routine early treatments were already excluded from prior authorization requirements before SB 1160 took effect. That existing structure may have limited the law’s measurable effect on overall utilization review approval rates.
For employers and construction contractors managing workers’ compensation exposure, the findings provide data on how early medical treatment decisions have changed under the revised review framework.
The study identified a measurable change in physical therapy access during the first 30 days following a workplace injury.
Among injured workers whose diagnoses indicated that physical therapy was recommended, the likelihood of receiving physical therapy during the initial 30-day period increased by 13% after SB 1160 was implemented.
The average time before a worker received an initial physical therapy appointment also declined. The study measured a reduction from 13.4 days to 11.9 days.
Researchers analyzed information from two large claims administrators, California’s Independent Medical Review database and the Workers’ Compensation Information System. The study period covered data from January 2017 through January 2024.
Workers’ compensation administration is a significant operational consideration for construction employers because workplace injuries can affect medical costs, claims management and workforce availability.
The findings indicate that SB 1160 did not materially change early treatment approval rates but was associated with somewhat faster access to guideline-supported physical therapy. For construction employers and workers’ compensation stakeholders, the results provide evidence on how the state’s utilization review framework has functioned since the law was implemented.
Source: DIR, State Of California.
