Cumulative trauma (CT) claims across California’s workers’ compensation system have risen sharply, with the share of indemnity claims involving CT reaching 26% in preliminary 2024 data, nearly double the 13% share recorded in 2012, according to a report by the Workers’ Compensation Insurance Rating Bureau of California (WCIRB).
Total pure premium costs attributable to CT claims have more than doubled since 2021, while costs for non-CT claims have increased by more than 30% since 2020.
CT claims arise from repetitive physically or mentally traumatic activities over time, rather than from a single incident. While such claims have long been a feature of California’s workers’ compensation system, the WCIRB noted that CT claim frequency has increased sharply in recent years, a trend that stands in contrast to the rest of the country, where CT claim rates have remained stable since 2013.
Post-Termination Filings and Litigation Drive Cost Pressures
One of the most significant drivers of the CT claim increase is the growing share of claims filed after a worker’s employment has ended. According to the WCIRB’s survey of claims from accident years 2022–2024, 58% of CT claims were filed post-termination, up from 44% in a comparable survey covering accident years 2013–2015. The report traced this trend in part to a series of judicial decisions beginning in 2011 that broadened the interpretation of limits on post-termination filings, particularly in the Los Angeles area.
Post-termination CT claims are almost universally litigated: the survey found 99% of such claims involved litigation, compared with 82% of non-post-termination CT claims. Litigation is the strongest driver of allocated loss adjustment expenses (ALAE) for CT claims overall, with average paid ALAE for litigated claims more than double that for non-litigated claims, the report found.
Geographic concentration also plays a role. Regardless of where in California the injury occurred, the vast majority of litigated CT claims are handled by law firms based in the Los Angeles area, a pattern the WCIRB attributed in part to the continued prevalence of remote hearings since the pandemic.
Workers with shorter job tenure are increasingly filing CT claims. The share of CT claims from workers with less than five years of tenure has grown, while the share from workers with 10 or more years of tenure fell from 25% in accident year 2020 to 18% in 2023, suggesting claims are being filed earlier in the employment relationship than in prior years.
Medical-Legal and Interpreter Costs Rise Disproportionately on CT Claims
CT claims carry a markedly different cost profile than non-CT claims, particularly in medical service utilization. For accident years 2022–2024, medical-legal services accounted for 37% of paid medical costs on CT claims in the first two years, up from 24% for CT claims in the 2017–2019 period. Physician services, inpatient care and outpatient care each represented a smaller share of CT medical payments by comparison.
Utilization of medical-legal services per CT claim has increased significantly faster than for non-CT claims, the WCIRB found, and the same pattern holds for psychological and psychiatric medical-legal evaluations, where CT claim utilization roughly doubled from 2014 levels on an indexed basis.
Interpreter service utilization has also grown faster for CT claims, with services per CT claim increasing to more than six times 2014 levels by 2024.
Growth in CT Volume Dampens Severity Trends
Despite rising total CT costs, the surge in CT claim volume has had a moderating effect on average severity figures across the system. Average paid indemnity has been flat for CT claims since 2017 while growing at roughly 5% annually for non-CT claims.
Similarly, average paid medical costs have been flat for CT claims since the pandemic but have increased about 3% annually for non-CT claims. The WCIRB noted that this influx of CT claims, which tend to have lower average costs at early maturities, has dampened overall statewide severity trend measurements for both indemnity and medical costs.
ALAE trends have not followed the same pattern, however. Because CT claims already carry higher average ALAE than non-CT claims, their growing frequency has not offset the rapid ALAE growth seen across the system, the report said.
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