Functional Restoration Programs in the California Workers’ Compensation System
Abstract
Functional Restoration Programs (FRPs) are multi-disciplinary programs used to treat injuries that involve chronic pain and improve patient function when the injuries do not respond adequately to traditional therapies. We analyzed 635 indemnity claims that involved FRPs compiled from the utilization review (UR) systems of California workers’ comp insurers. Using demographic, bill review, and medical data, we compared the FRP claim sample to 270,165 non-FRP indemnity claims to determine how they differ in terms of claim characteristics, geographic region, and clinical conditions. We also compared the FRP sample to a matched group of 2,361 non-FRP indemnity claims with similar clinical, demographic, and claim characteristics to more precisely assess differences in treatment costs, temporary disability duration, and overall claim duration. We found that unlike the broader indemnity claim population, which is primarily based in Southern California, FRP claims were concentrated in the Bay Area (nearly half) and the Central Valley (over a quarter). FRP claims were also more likely to involve attorney representation (94.0% vs. 50.8%), and although MTUS guidelines specify FRPs for chronic pain patients, only 42.8% of claims included a chronic pain diagnosis, possibly due to coding issues or participation by patients without chronic pain. FRP claims have higher overall costs, longer temporary disability days, and longer claim durations compared to matched non-FRP claims.