Comorbidity and Workers Compensation

Among the most difficult workers compensation claims for the adjuster to resolve are the situations where the injured employee has the simultaneous presence of the work related injury and another medical condition. In science, morbidity refers to a diseased state, disability or poor health due to any reason. Comorbidity refers to having two unrelated medical issues at the same time which impact the individuals recovery from either condition. The workers compensation adjuster will often cringe when they learn that the injured employee is also suffering from other health issues, as the adjuster knows the claim will most likely turn into a long, drawn-out affair.

While any health issue can create a comorbidity problem, the more common employee health issues the work comp adjuster will have to deal with include:

1. diabetes

2. obesity

3. drug addiction

4. tobacco addiction

5. alcohol addiction

6. depression

7. hypertension

8. mental health issues

9. heart problems

10. immune system issues

Any of these personal health issues can create a complicating condition that interferes with the employees recovery from the on-the-job injury. The comorbid condition will either delay the employees medical recovery, or complicating the employees ability to return to work, either on modified duty or full duty.

The cost of the medical treatment and the cost of disability benefits of the workers comp injury are normally far higher when there is a comorbidity issue. For instance, a study by Duke University Medical Center showed that obese employees filed twice as many work comp claims, their medical expenses were nearly 7 times higher than non-obese employees and the obese employees were off work 13 times as long as the non-obese employee who incurred the same type and degree of injury.

Other research has shown a strong correlation between the existence of a comorbid condition and higher claim cost.

Some of the research results include:

1. People who smoke are six times more likely to have complications with a wound healing.

2. Depression, where it existed prior to the injury, or was developed because of the injury, often delays the employees return to work.

3. Hypertension, while a prevalent complicating condition, that increases the claim cost, the increase in claim cost is lower than most other comorbid conditions.

4. No comorbid condition lowers the overall workers compensation cost in either medical expenses or indemnity benefits.

5. Employee’s who smoke or have an addiction to alcohol frequently become addicted to narcotics if narcotics are prescribed for pain.

6. Pity the work comp adjuster who has a severe injury claim for a morbid obese, depressed, alcoholic with diabetes who got hurt on the job. The likelihood of every getting the employee back to work is nil, statistically speaking.

Implement a Wellness Program
While it may be tempting to say “thats the adjusters problem”, the employer can have a positive and direct impact on the cost of workers compensation claims by addressing the health issues of the employee before an accident occurs. Many of the conditions that create a comorbidity problem are potentially preventable, and if not preventable, treatable before the injury occurs. There are several steps an employer can take to create a holistic approach and reduce the increased cost of comorbid claims.

These steps include implementing components of well-ness programs including:

1. A weight reduction program offered through your human resources office.

2. A healthy work culture that prevents smoking at the work site and offers smoke cessation program.

3. A healthy work culture that offers water and healthy snacks in the snack machines, rather than sodas and candy.

4. An encouragement of physical activity at the workplace including taking the stairs and parking at the end of the parking lot to walk to the factory or office building.

5. Health insurance premium discounts for individuals who do not smoke and maintain a healthy weight

Use Nurse Case Management
When an employee who has a preexisting medical condition is injured on the job, early intervention in the medical care by a nurse case manager can impact favorably the future outcome of the work comp claim. The nurse case manager can work with the adjuster, treating physician and employee to coordinate the medical care and manage the underlying pathology creating the comorbid condition.

With an aging workforce brought on by the baby boomer generation reaching their 50s and 60s, the number of work comp claims complicated by hypertension, obesity, diabetes and other comorbid conditions will continue to increase. By the employer being aware of how the health issues of the employees impact their cost of workers’ compensation, the employer can steps to improve the overall health of the employees, lowering both the cost of workers compensation and health insurance.

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