Comorbidity Run Amuck – Medical Conditions Make Work Comp Injuries More Costly

Comorbidity is the presence of two or more medical conditions in a person at the same time. When an employee with a prior medical problem has an on-the job injury, the cost of the medical care and the length of time the employee will be off work is normally extended. This does not mean that workers compensation will pay for an employee's pre-existing medical problems, but it does mean that the pre-existing medical problems can complicate the medical care for the workers compensation injury.
When an employer takes an active interest in the medical status of its employees, it has a far reaching positive impact. Take for example the trucking company that did not have an overall wellness program for its employees. It was not only paying more for the cost of health insurance, it was paying more for the cost of workers compensation insurance. And then the inevitable happened: a truck driver with several — not one or two health issues — but several health issues got hurt on the job.(WCxKit)
The truck driver, who was driving a tanker truck, decided to check the level of the liquid in the tanker. The driver, 51, climbed up on the catwalk. To hold on, he took hold of a handle for that purpose, but lost his balance and started to fall. By holding on to the handle, he was able to prevent the fall, until all of his 297 pounds was on his arm and shoulder. Rip went the rotator cuff in his shoulder, pop went the handle as it was there for balancing, not to hold 297 pounds, and the trucker fell to the ground.
The doctor's immediate assessment was probable torn rotator cuff. The MRI confirmed a large rotator cuff tear in this very large guy. Normally, the doctor would schedule surgery, repair the rotator cuff, and send the employee to physical therapy for six to eight weeks, returning the employee to light duty in four weeks and returning the employee back to work full duty in eight to 10 weeks.
The obesity alone would not have been much of a factor for rotator cuff repair, but the issue that caused the obesity was. The trucker liked beer. A lot of beer, which is how he got to 297 pounds. But the alcohol also brought on other comorbidity factors including hepatitis C and cirrhosis of the liver. The orthopedic doctor did what any other doctor would do, he delayed the surgery until the claimant could get surgical clearance from the gastroenterologist. The gastroenterologist could not see the claimant immediately and four weeks of temporary indemnity benefits were paid while the claimant waited the appointment with the gastroenterologist.
The gastroenterologist agreed to take the claimant off antiviral medications. The claimant's body needed at least three months to adjust to not having the antiviral medications and for his platelet count to recover adequately for the rotator cuff surgery. Another three months of indemnity benefits.
The rotator cuff surgery was completed, but then diabetes came into play (I should have mentioned earlier that the trucker was also a diabetic). Three weeks post surgery, the area around the surgical wound began to turn red. Due to hyperglycemia, brought on by the diabetes, cellulitis (infection) of the wound and surgical area developed. The driver went back to the hospital for another surgery to surgically remove the infection. Of course when the wound was opened, the rotator cuff had not healed due to cellulitis and had to be repaired again. The second rotator cuff surgery caused by the comorbidity of diabetes adds both additional medical cost and another three weeks of indemnity benefits, as all the recovery time between the first surgery and the second surgery is loss.
When you are immobile due to obesity and recovering from two surgeries, have hepatitis C, cirrhosis and diabetes, it is nothing unusual to develop edema (where the body retains excessive levels of fluid). When you are severely bloated, it is difficult to actively participate in physical therapy. With drugs for the edema, physical therapy was only delayed two weeks, but this was two extra weeks of indemnity benefits in addition to the medical cost of the doctor's visit and the pharmacy.
For brevity of this article, we will not discuss the hypertension and basilic vein clot/thrombosis and how they delayed the medical recovery that further extended the time the employee was drawing indemnity benefits. Also, for brevity we will not discuss the employee's anxiety, depression, panic attacks, insomnia, abdominal pain, jaundice, and weight loss issues as these conditions individually did not prolong the worker compensation claim, but collectively added to the medical cost as the primary doctor had to address the issues or refer the medical issues to other doctors.(WCxKit)
While few workers compensation claims have this many medical complications, the non-work related medical issues of your employees will interfere with the recovery from the on-the-job injury. You can reduce the cost of both health insurance and workers compensation insurance by encouraging your employees to individually maintain good health and by providing a wellness program.

Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See for more information. Contact:
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
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