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Pre-existing Conditions Weight Heavily on Workers’ Comp Claims


Your workers’ underlying health can greatly affect the amount of time they are off the job recovering from a workplace injury.

A new study has found that workers with pre-existing health issues like hypertension, obesity and mental health spend 60% more time recovering from workplace injuries than healthy workers. And because those injured workers are collecting wage-replacement indemnity benefits during that time, the cost of a claim increases in kind.

The findings illustrate the importance of trying to keep your workers healthy through wellness programs and access to health insurance.

The findings in the study of more than 7,000 workers’ compensation claims by Newport Beach, Ca.-based Harbor Health Systems found that in addition to increased claim duration, these underlying health issues affect the cost of claims, increase temporary total disability (TTD) days, recidivism (aggravating of the original injury), and lead to more litigation and surgery.

 

The study looked at seven “comorbidities”:

  • Obesity
  • Diabetes
  • Hypertension
  • Addiction
  • Mental health
  • Tobacco use and
  • Multiple comorbidities (one or more of the above)

 

Shocking outcomes

The results of the study were a confirmation that underlying health problems will worsen outcomes.

The two comorbidities that have the greatest impact are multiple comorbidities and obesity, followed by addiction, mental health and hypertension, with diabetes and tobacco having the lowest impact.

Relationships between comorbidities – such as the link between obesity and diabetes – can exacerbate complications and health risks. The age of the injured worker is another factor that is associated with comorbidities and can complicate the management of a claim.

 

Duration and cost

  • For claims involving multiple comorbidities, claim duration increased by 76%.
  • For claims involving addiction, duration increased 67%.
  • For claims involving obese individuals, duration increased 55%.
  • For claims with multiple comorbidities, total incurred costs increased 341%.
  • Claims in all the comorbidity groups had significantly higher TTD days compared to the control group.
  • TTD days increased by 285% for multiple comorbidities claims and 274% for addiction-related claims.

 

Litigation

  • Litigation rates for claims with multiple comorbidities increased 147%.
  • Litigation rates for addiction-related claims increased 224%.
  • Litigation rates for mental health-related claims rose 248%.

 

The takeaway

Employers can encourage their employees to improve their health through company wellness plans and ensure that they have access to health insurance to treat their medical issues.

Claims management experts say that insurance company adjusters need to intervene early in cases where injured workers are saddled with these comorbidities.