California Workers’ Comp Underwriting Loss Widens As Medical And Indemnity Costs Both Rise
California workers’ compensation insurers recorded a pre-tax underwriting loss of 2.8% of earned premium in 2025, or roughly $431 million, a reversal from the 0.8% underwriting profit posted in 2024, according to the Workers’ Compensation Insurance Rating Bureau of California.
The WCIRB’s 2025 California Workers’ Compensation Losses and Expenses report found that calendar year 2025 earned premium totaled $15.4 billion, down from $15.6 billion in 2024, while total incurred losses and expenses climbed to $15.7 billion, or 102% of earned premium. Insurer loss adjustment expenses rose to 18% of earned premium in 2025 from 16% in 2024, and total incurred expenses reached 40% of earned premium, up from 38% a year earlier.
Medical And Indemnity Payments Both Rise
Total loss payments in 2025 split nearly evenly between medical and indemnity benefits, with $5.2 billion, or 52% of total loss payments, going toward medical benefits and $4.7 billion, or 48%, toward indemnity benefits, including vocational rehabilitation, the WCIRB reported.
Total medical losses paid were essentially unchanged from the $5.2 billion recorded in 2024, though that figure represented 54% of total loss payments that year, compared with $4.4 billion, or 46%, for indemnity benefits in 2024. Within medical spending, payments made directly to injured workers totaled $1.69 billion, up from $1.68 billion in 2024, while medical-legal evaluation payments rose to $480 million from $450 million. Physician services fell slightly to $1.37 billion from $1.39 billion, and hospital payments declined to $0.55 billion from $0.57 billion.
Medical-legal evaluations averaged $2,220 in 2025, with orthopedic evaluations accounting for about 50% of total medical-legal evaluation costs, the WCIRB found. Psychiatric and psychologist/behavioral health evaluations remained the most expensive category, averaging $3,778.
On the indemnity side, temporary disability benefits made up 59.2% of paid indemnity in 2025 and permanent partial disability benefits accounted for 31.6%, according to the report. Vocational rehabilitation-related benefits totaled about $88 million, or 1.9% of all indemnity payments, of which 90% went toward education-related benefits, roughly consistent with 2024’s $85 million, also 1.9% of indemnity payments and 91% education-related.
Defense And Applicant Attorney Costs Increase
Incurred loss adjustment expenses in 2025 included $1.09 billion in defense attorney expenses, up from $1.07 billion in 2024, the WCIRB reported. Separately, fees paid to applicant attorneys, which are generally embedded in indemnity losses rather than reported as expenses, totaled $506 million in 2025, up from $420 million in 2024, based on the WCIRB’s Annual Expense Call.
Total paid cost of medical cost containment programs, split between medical loss and allocated loss adjustment expense, rose to $457 million in 2025 from $428 million in 2024, with $347 million of that total reported as allocated loss adjustment expense.
Total insurer paid losses, excluding payments made by the California Insurance Guarantee Association, were $9.8 billion in 2025, or 64% of earned premium, up from 61% in 2024. Combined with a slight decrease in loss reserves, total insurer incurred losses excluding CIGA payments reached 62% of earned premium, compared with 61% in 2024.
Injury Patterns Show Slip-And-Fall Claims Most Costly
Among permanent disability claims from policy year 2023, slip-and-fall injuries were both the most frequent and most costly injury category, according to WCIRB data. Slip-and-fall claims carried an average incurred cost of $105,965 per claim, including $42,295 in indemnity and $63,670 in medical costs, and accounted for 27.9% of total incurred losses on permanent disability claims.
Back injuries followed, averaging $64,506 per claim and representing 15.5% of total incurred losses. Carpal tunnel and repetitive motion injuries averaged $41,501 per claim, other cumulative injuries averaged $34,757, and psychiatric and mental stress injuries averaged $28,746, the lowest among the categories tracked.
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