CWCI data reveals FRPs are pricier, longer, and more complex than traditional treatments, raising questions about their role in chronic pain care.
Functional Restoration Programs (FRPs) are marketed as a last-resort, multidisciplinary solution for injured workers stuck in cycles of chronic pain. But a new study from the California Workers’ Compensation Institute (CWCI) suggests they may come with a hefty price tag and prolonged timelines—without always aligning with clinical guidelines.
Analyzing 635 indemnity claims involving FRPs against more than 270,000 non-FRP claims, CWCI’s researchers found striking differences in cost, duration, and claim dynamics. The study offers the first comprehensive look at how FRPs are actually used in California’s workers’ comp system, and whether the promise matches the practice.
Bay Area Hotspot, Attorney Magnet
FRP claims weren’t spread evenly across the state. Nearly half came from the Bay Area, with another quarter based in the Central Valley—unlike the broader claim population, which skews heavily toward Southern California.
Another standout stat: legal involvement. A staggering 94% of FRP claims had attorney representation, nearly double the rate of other indemnity claims (50.8%). And despite guidelines recommending FRPs only for chronic pain cases, fewer than half (42.8%) of the claims carried that diagnosis—raising questions about coding accuracy or whether programs are being prescribed more broadly than intended.
Slow Starts, Longer Runs
On average, workers didn’t enter FRPs until 792 days—more than two years—after their first medical service, and only after racking up nearly 40 conventional physical therapy visits.
Once enrolled, FRPs lasted a median of 8 weeks, outpacing the state’s Medical Treatment Utilization Schedule (MTUS) recommendation of 4–6 weeks. While most injured workers received 20–40 treatment days (consistent with utilization review approvals), they averaged only 3.8 days per week—short of the MTUS benchmark of 5 days per week.
Not surprisingly, FRP requests drew more scrutiny from insurers. CWCI found 25% of FRP-related utilization review (UR) requests were denied, compared to under 8% for non-FRP medical services.
Costly by Every Measure
FRPs didn’t just take longer—they cost more. A lot more. Average FRP claim costs hit $234,003, or nearly 60% higher than matched non-FRP claims ($146,933). Medical costs were twice as high, while indemnity and expense costs each ran about 28% higher.
The billing practices played a role. About a third of procedure codes used to bill FRPs weren’t listed in California’s Official Medical Fee Schedule, yet they accounted for 84% of total FRP treatment costs. Payments tied to these unlisted, bundled codes averaged $1,751 each—roughly $350 per treatment hour.
More Time Out, Longer Claims
Injured workers in FRPs spent more time off the job too, averaging 520 days of temporary disability (TD), versus 415 days for comparable non-FRP claims. Overall claim duration stretched to 1,287 days—27% longer than the 1,013-day average for the control group.
Given that California caps TD benefits at 104 weeks within five years of injury, CWCI notes that many FRP cases far outlast the state’s disability window.
The Bottom Line
The CWCI study paints a complicated picture. FRPs are longer, costlier, and more legally entangled than traditional treatments, and often fall short of state guidelines on timing and frequency. Yet for workers struggling with unresolved injuries and pain, they remain one of the few structured options available.
As California’s workers’ comp system grapples with rising costs and utilization challenges, FRPs may find themselves at the center of a familiar debate: do their outcomes justify their expense?
CWCI’s full report is available to members and subscribers at cwci.org.
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Business Wire, a Berkshire Hathaway company, is the global leader in press release distribution and regulatory disclosure. Public relations, investor relations, public policy and marketing professionals rely on Business Wire for secure and accurate distribution of market-moving news and multimedia. Founded in 1961, Business Wire is a trusted source for news organizations, journalists, investment professionals and regulatory authorities, delivering news directly into editorial systems and leading online news sources via its multi-patented NX network. Business Wire’s global newsrooms are available to meet the needs of communications professionals and news media worldwide.
