WCIS eNews No. 59
August 7, 2006

Uses of the WCIS database

At initial meetings of the FROI/SROI Task Force, participants requested background information concerning uses of the WCIS database. This e-news describes current projects and also includes examples of how the database has been used since 2005.

A. Major projects using WCIS data that are currently underway or about to be undertaken by DWC include:

1. Timeliness of Payments Reports by Claim Administrator have been requested by a member of the California legislature. For this analysis, DWC needs and is updating trading partner profiles that contain accurate supplemental claim administrator lists.

2. DWC is analyzing all available information about permanent disability claims from data in the WCIS in connection with DWC’s mandate from the legislature. SB 899 requires that empirical data on lost earnings by permanently disabled workers be incorporated into future versions of the disability rating schedule on regular five-year intervals.

3. Beginning later this year, illness and injury incidence rates for workers in California industries will be calculated on a quarterly basis.

4. In the near future, California claim administrators who report complete and accurate information to the WCIS will no longer have to submit the paper Annual Report of Inventory to DWC’s Audit Unit. The Audit Unit will use information about claim administrator activity from the WCIS instead of analogous data from the Annual Report of Inventory.

B. Several other significant work-in-progress items are pertinent to the work done at DWC with respect to the WCIS. Most importantly, DWC has:

1. Created an Implementation Guide (IG) for medical bill payment records that received approval by the Office of Administrative Law (OAL) in March 2006. The IG will be used to collect detailed medical data from WCIS trading partners/claim administrators beginning September 2006. This IG represents the result of a huge effort by WCIS staff and a host of industry stakeholders to enhance the utility of the WCIS.

2. Prepared and is sharing detailed data quality reports for the industry and with trading partners requesting individual company reports. The aim is to significantly improve the quality of information about workers’ compensation claims available from claim administrators statewide.

3. Created a task force to review and recommend changes to the WCIS Implementation Guide for collecting FROI/SROI data to better serve all stakeholders’ needs.

C. Examples of how DWC has used the WCIS database since 2005 include:

1. For the Employment Development Department (EDD) -- DWC compared State Disability Insurance (SDI) claims with Social Security Number matches in the WCIS database. Moreover, EDD and DWC have agreed that DWC should perform matches like this on a regular basis for the SDI.

2. For the Workers' Compensation Insurance Rating Bureau (WCIRB) -- DWC performed two analyses: first, DWC examined the number of total reported injuries and denied claims in 2003 and 2004, for both insured and self-insured employers, with the purpose of estimating the impact of reform legislation. DWC also provided the Bureau with a data matrix/report on the total count of claims, by year/month, by date of injury and employer/claim administrator knowledge for all claims in the WCIS database for further analysis and study by WCIRB staff.

3. For the Bureau of State Audits -- DWC analyzed FROI data for selected companies involved in the Bay Bridge major construction project, including the use of:

o the FEINs reported by construction companies;
o the various company names/subsidiary names reported by business entities;
o the class codes used by insured and self-insured business entities.

4. For the Department of Health Services (DHS) -- DWC provided DHS with data files or extracts for injuries related to asthma, carpal tunnel syndrome, and silicosis for use by DHS to monitor, further analyze and follow up work on these injuries.

5. For DIR’s Division of Occupational Safety and Health (DOSH) -- DWC provided data for selected injury types by part of body, such as eye-related injuries. DWC also provided DOSH with an analysis of heat-related injuries/illnesses to agricultural workers and an analysis of occupational back and back-related injuries in California hospitals, by part of body and cause of injury.

6. For law enforcement entities -- DWC used the WCIS occasionally in connection with fraud-related work.

7. For university researchers -- In 2005, DWC supplied a large and complicated data extract (representing 73,000 claims) to a UCSF researcher for the Nurse Workforce Initiative Study. In 2006, a much larger data extract was provided to a researcher at Boston University to conduct an analysis supported by Commission on Health and Safety and Workers' Compensation (CHSWC). Sample data from the WCIS database were also used for a medical access study contracted by the DWC with UCLA. About 6,000 claims with injury data during a specified period in 2005 were extracted from WCIS for purposes of the UCLA study.

8. For the public -- the WCIS webpage (http://www.dir.ca.gov/DWC/WCIS.htm) contains descriptive tables that provide information to the public about important characteristics of workers’ compensation claims in California, such as claims by year and by part of body, nature of injury, cause of injury, type of insurer, age and gender. A brief study on “Age, Gender and Insurer Segment Characteristics of Workers’ Compensation Claimants” is also posted.

9. For DWC’s Administrative Director (AD) and other internal uses -- DWC regularly performs ad hoc analyses and data queries that are used to assess the performance of the workers’ compensation system in the state and help the AD to make informed policy decisions affecting the industry. DWC has a set of “point and click” or user-friendly menu screens that allow staff to analyze selected WCIS information about:

a. injury characteristics, at a particular point in time or for selected time periods, by part of body, nature and cause of injury;
b. workers’ demographic and work characteristics;
c. claims by county and geographic region;
d. claims by benefit category;
e. claims by insurer type;
f. timeliness of benefits delivery; and
g. cost of injuries by gender, age at injury, nature of injury and benefit category.

Damon Chen
email: dcchen@dir.ca.gov
phone: 510-286-6753
fax: 510-286-6862
Trading partner letters C, G, H, M, P-R

Elisema Cantu
email: ecantu@dir.ca.gov
phone: 510-286-6763
fax: 510-286-6862
Trading partner letters B, D-F, N, O, W-Y

Johnny Lee
phone: 510-286-6772
fax: 510-286-6862
Trading partner letters A, I-L, S-V, Z

Contents of this bulletin do not change existing regulatory requirements; they provide additional or revised detail about the technical implementation of those requirements. All technical changes will subsequently be reflected in other WCIS documentation. Any bulletin can be forwarded as needed, but should be forwarded in its entirety and without modification. If you have received a forwarded copy of this bulletin and are concerned about its authenticity, you can view this and previous bulletins on our WCIS web site: http://www.dir.ca.gov/dwc/wcis.htm.

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