27 Jul 2021

Workers’ Compensation Medical Treatment in the COVID-19 Era

A new study examines the impact COVID-19 had on the timing and prevalence of medical treatment for non-COVID injuries under workers’ compensation in 2020

Now that more than a year has passed since the onset of the COVID-19 pandemic, researchers have had the time to assemble and analyze some data on the impact of the pandemic on workers, worker injuries, and treatment for those injuries. One new WCRI study, “The Early Impact of COVID-19 on Medical Treatment for Workers’ Compensation Non-COVID-19 Claims,” by Olesya Fomenko, adds to this growing body of research by looking at whether and to what extent the pandemic changed the timing and patterns of medical treatment for non-COVID workers’ compensation claims.

For purposes of this study, the author looks at workers’ comp claims data from 27 states, among them California, Florida, Texas, Pennsylvania, and New Jersey (but not New York), which in total represent 68 percent of the workers’ compensation benefits paid in the US. The claims data generally comes from private sector workers and local public employees covered by workers’ compensation, such as police and firefighters, but not state or federal workers. The study collects data on injuries that were sustained in the first half of 2019 and compares that data with the same data for injuries sustained in the first half of 2020, at least some of which would have been sustained in the early months of the pandemic. For some of the analysis, the study also looks at claims from the second half of 2019 that had treatment in the first half of 2020 and compares this treatment data with data for injuries from the second half of 2018 that had treatment in the first half of 2019. The study does not include claims that directly involved COVID-19.

In order to organize this data, the study breaks the data down by eight main service types, including evaluation and management, emergency care, physical medicine, neurological and neuromuscular testing, pain management injections, major surgery, major radiology, and minor radiology, which together generally make up about 84 percent of total medical payments across the states. However, the study does not distinguish between services provided in person and those provided through telemedicine, a distinction that in and of itself might be an interesting subject of study given the nature of the COVID pandemic.

Time From Injury to Treatment

The first group of findings discussed in the study involves the time from a worker’s injury to the receipt of medical treatment for non-COVID claims. While the author had in a previous study found that the total number of non-COVID workers’ comp claims had decreased anywhere from 30 to 50 percent in the second quarter of 2020, this newer study finds that for claims with injury dates in the second quarter of 2020, when the pandemic was in full force, there were no appreciable delays in receiving medical treatment compared to the time from injury to treatment for claims with injury dates in the second quarter of 2019. In fact, some service types, including emergency room service, physical medicine, major surgery, and neurological/neuromuscular testing, reduced the time from injury to treatment for those second quarter 2020 claims. The results were basically the same when comparing injuries from the first quarter of 2020 with those from the first quarter of 2019: no indication of longer times from injury to treatment in 2020 and somewhat shorter times for receiving emergency care services. Consistent with those results, for injuries sustained in the second half of 2019 that required treatment in the first half of 2020, there was no evidence of delays in medical treatment compared to a year earlier and some treatment types were provided sooner.

As to those states in the study hit hardest by the COVID-19 pandemic in the Spring of 2020, specifically Connecticut, Massachusetts, and New Jersey, the evidence supported the same conclusion that injured workers generally did not face delays before receiving treatment in comparison to the year before. In fact, the waiting time before major surgery on average dropped by about five days for claims in the second quarter of 2020, while the time from injury to pain management injections decreased by about seven days. In these hardest-hit states, the study did find small increases in the second quarter of 2020 of a half-day to a day between injury and minor radiology and evaluation and management services.

Because of the different relative necessity for receiving prompt treatment for different medical conditions, the study also compared two traumatic injury types, fractures and lacerations, with two soft-tissue conditions, spinal and non-spinal sprains and strains. For the fractures and lacerations sustained in the first half of 2020, the study found no delays in receiving treatment compared to similar injuries in the first half of 2019, and even slightly shorter waiting periods before receiving emergency services and the first physical medicine visit. For the soft-tissue strains and sprains, the study found that the time to minor radiology services increased slightly in the second quarter of 2020, but the time before initiation of physical medicine services dropped by about a day. In the first quarter of 2020, these soft-tissue injuries resulted in an increase of about three days before major surgery compared to 2019, but the time before evaluation and management services, emergency services, and minor radiology decreased. For existing claims for injuries sustained in the second half of 2019, for which initial treatments were generally provided prior to the onset of the pandemic, the study finds little evidence of delays in treatment required in 2020 for either the traumatic or soft-tissue injuries and somewhat shorter wait time for major surgeries for most of these claims, although the study does note about an 8-day increase in average wait time before neurological/neuromuscular testing for spine strains and sprains sustained in the third quarter of 2019.

Worker Avoidance of Medical Treatment?

The study finds evidence that injured workers in the early months of the pandemic may have been avoiding some types of medical services in order to reduce risk of COVID-19 exposure, such as, for example, emergency room services, which showed a 4 percentage point drop in the share of second-quarter 2020 claims. Similarly, the share of claims with major radiology dropped by 2 percentage points in that period. For injury claims from the first quarter of 2020, the study found about a 3 percentage point drop in claims with major surgery and about a 2 percentage point drop in claims with pain management injections.

The study found more pronounced changes when looking specifically at the three hardest-hit states in the northeast, Connecticut, Massachusetts, and New Jersey, with a larger 8 percentage point drop in the share of claims with emergency services when comparing the second quarter claims of 2020 with those of 2019, and drops of about 6 percentage points in claims with physical medicine and major radiology services. For claims in those three states with injury dates in the first quarter of 2020, the study also found decreases in the share of claims with specific services, such as a decrease of 3 percentage points in claims with major surgery and pain management injections and a 4 percentage point drop in claims with emergency services.

Focusing again specifically on the difference between traumatic fracture and laceration injuries and soft-tissue strains and sprains, when comparing second-quarter 2020 claims with second quarter 2019 claims, the study found some small variances, with 3 percentage point drops in 2020 claims with emergency room use for fractures/lacerations/contusions, compared with 4 percentage point drops in soft-tissue claims with emergency room use, which makes sense as the injured worker with a traumatic injury would be less likely than a worker with a soft-tissue injury to forego a needed trip to obtain emergency services even in the face of potential COVID exposure.

As to the average number of unique visits for specific types of medical services, which is generally relevant for evaluation and management services, physical medicine, and minor radiology, the study generally found no substantial change in the number of visits per claim from 2019 to 2020. When looking just at the states hardest hit by the pandemic in early 2020, the numbers were generally stable from 2019 to 2020 as well, although the study did find for those states an average decline of 1.4 physical medicine visits for claims originating in the fourth quarter of 2019.