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Digital EditionHow to Manage the Growing Complexity of Cumulative Trauma Claims in Workers’ Compensation
The nature of workers’ compensation claims is changing. While overall claim volume has declined in recent years, the claims that remain are growing more complex — and nowhere is that more evident than in California, where cumulative trauma claims have become a bellwether for the rest of the country.
In 2018, cumulative trauma represented roughly one in eleven California claims. By 2025, that figure climbed to nearly one in six. These claims tend to stay open longer, cost more, and are far more likely to end up in litigation than traditional single-incident injuries.
“From CorVel’s perspective, we’re seeing fewer comp claims than we did years ago, but the claims we are managing are becoming much more complex,” said Karen Thomas, Vice President of Clinical Solutions at CorVel. “Cumulative trauma is one example of that, particularly in California.”
What California’s Cumulative Trauma Surge Reveals
Karen Thomas, Vice President of Clinical Solutions, CorVel
Cumulative trauma refers to injuries that build upon themselves over time. These can be physical, such as carpal tunnel or repetitive motion injuries, or psychological, such as the toll experienced by first responders and hospital workers. In either case, they rarely trace back to a single incident on a single day; which runs counter to how workers’ compensation has traditionally been structured.
Thomas pointed to several factors driving the shift. The workforce is aging, with more people working later in life and more part-timers in the 55-and-above demographic. Work environments have evolved. And the claims process itself has changed since 2018.
“We might be looking at exposure over time; multiple body parts, prior health issues, conditions or treatments, jobs that change, and even behavioral factors that can influence recovery,” Thomas said.
That complexity has consequences. Cumulative trauma claims are more costly, stay open longer, and generate higher litigation rates. Claims with a psychosocial diagnosis have a 1.5 times higher average total incurred, remain open nearly twice as long, and are litigated at twice the rate of comparable claims.
“The important question isn’t simply why we’re seeing more cumulative trauma claims,” Thomas said. “It’s how we recognize that complexity early enough to change how we manage recovery.”
Why Case Managers Everywhere Should Be Paying Attention
Thomas believes case managers and payers in other states should view the data coming out of California as a preview rather than an anomaly.
“I wouldn’t assume every state will follow California’s trajectory, but there are lessons here for anyone managing complex claims. We need to recognize when recovery isn’t progressing as expected and understand what’s contributing to that,” Thomas said.
Rather than bracing for impact, she sees an opportunity. The higher incurred rates, longer temporary total disability durations, and elevated litigation rates seen in California are not inevitable. They are the downstream result of claims that weren’t managed proactively from the start.
A central lesson is that physical recovery and psychological well-being can no longer be treated as separate concerns. Even a well-designed treatment plan can falter if the injured worker is fearful of reinjury, struggling with disrupted sleep, worried about returning to work, or anxious about financial pressures.
“We can’t really separate physical recovery from psychological well-being like we used to,” Thomas said.
“After twenty-six years in the industry, I’m glad we’re recognizing how important it is to look at the whole person, including the factors that may be affecting their recovery.”
The data doesn’t suggest that mental health causes poor outcomes, but it clearly shows that when behavioral health intersects with a physical injury, claims become more complicated. For case managers across the country, the implication is clear: identifying those intersections early is essential to keeping claims from spiraling.
Best Practices for Identifying and Managing Cumulative Trauma Claims
Thomas emphasized that managing cumulative trauma well doesn’t require more services or heavier interventions. It requires better timing, better communication, and the thoughtful application of both data and clinical judgment.
1. Treat the first 30 days as a trust-building window, not an administrative period.
“During those first thirty days, the injured worker is developing trust,” Thomas said. “They’re judging how the team is responding to them, whether it’s the adjuster, the employer, or even the provider. If they don’t get what they need or want, that’s when things are going to escalate.”
Simple interventions during this window; a check-in phone call, clear expectations about recovery, an employer reaching out to a worker experiencing anxiety; all of these can prevent minor concerns from becoming litigated claims.
2. Combine predictive analytics with clinical judgment.
Data analysis can flag risk patterns across thousands of claims, but it cannot interpret what those patterns mean for an individual. That requires clinical expertise.
“We’ve become very good as an industry at identifying the risks, but that isn’t the same thing as knowing what to do about it,” Thomas said. “Data can tell us where to look. Then you need to apply clinical judgment to understand what that information means for the person in front of you, because every person is unique.”
The partnership works in both directions. Nurses may notice patterns in their conversations with injured workers that can be tested against the analytics; the analytics may surface trends that clinicians can then investigate on an individual level.
3. Build and act on a risk profile from day one.
At CorVel, 24/7 triage nurses document behavioral indicators and social determinants from the first point of contact. Early intervention nurses then follow up, building a risk profile and making specific recommendations to the adjuster.
“Nurses know that, for example, perhaps this is a roofer who’s fallen off the roof. This person is the only breadwinner for the family,” Thomas said. “Now he’s going to receive 66 and two-thirds of his payment, which is going to cause a hardship and stress. We need to pay attention to that because it’s going to impact the recovery.”
The goal isn’t to add layers of nurse involvement, Thomas said, but to queue up simple, timely actions for claim professionals — like a phone call at the two-week mark — that keep the claim on track.
4. Keep all stakeholders aligned.
Establishing shared expectations for what recovery should look like, and watching for signs that the worker, adjuster, employer, or provider is drifting from those expectations, is critical.
“Keeping the communication open and making sure that everyone understands what’s happening is vital, because uncertainty can affect recovery,” Thomas said.
5. Don’t wait until the claim is in crisis.
Thomas offered a cautionary note about a tendency on the part of insurers and other payers to bring in clinical support only after a claim has gone off the rails.
“Historically, nurses were often brought into claims after years of unsuccessful treatment, when there were already significant barriers to recovery. By that point, there are so many layers of history to work through. We have a much better opportunity to influence recovery when clinical expertise is involved earlier.”
A More Human Approach to Complex Claims
The trends emerging from California are a signal, not a sentence. With the right combination of timing, communication, and clinical insight, even the most complex cumulative trauma claims can be guided toward better outcomes.
“This is just really about dialing into what that human is going through at that particular moment in time and how we can drive better focus to achieve quicker recovery and return to work,” Thomas said. &
