One Call Expert Says Comorbidities Complicate Workers’ Comp Claims

In workers’ compensation, seemingly straightforward injuries may turn into prolonged and costly claims when comorbid conditions exist. These comorbidities can end up complicating treatment, recovery and return to work. Eric Patten, senior director of clinical at One Call Care Management, delivered a session on the topic, “Strategies to Manage the Pandora’s Box of Comorbid Conditions,” at the recent Risk Management Society Conference.

Comorbid conditions that commonly impact workers’ comp claims include obesity, diabetes, hypertension, mental health issues, tobacco use and substance abuse.

“Workers’ compensation professionals need to understand the scope of these comorbid conditions and how they impact workers’ compensation programs,” said Patten. “For example, as many as half of Americans may soon be obese, and one-third may have diabetes or pre-diabetes. These insights can help workers’ compensation programs develop clinical strategies to better manage claims that have comorbidities. Identifying such conditions early enables a more holistic view of the patient’s health, and a more comprehensive approach to care that can truly impact costs and outcomes.”

According to a report from the National Council on Compensation Insurance released in October 2012, the number of workers’ compensation claims with a comorbid condition nearly tripled from 2000 to 2009. This report also showed that claims with a comorbidity had about twice the medical costs of otherwise comparable claims.

In general, comorbidities impede an injured worker’s ability to heal, recover and return to work. As a result, claims with comorbidities on average will experience:

• Longer claims duration
• Higher medical and indemnity costs
• More temporary disability (TTD) days
• Increased litigation rates
• Increased surgery rates

“As injured workers age, there’s a higher likelihood that they may have another condition in addition to their worksite injury,” noted Patten. “In fact, with today’s aging workforce, comorbidities may soon become a complicating factor on most claims. We may even see an increase of claims with two or more comorbidities, such as hypertension and anxiety, or arthritis and a history of substance abuse.”

In 2016 Harbor Health Systems, a One Call Care Management company, performed a study of comorbidities and found that claims with multiple comorbidities experienced a 341 percent increase in total incurred costs, and 285 percent more TTD when compared to the control group.

“Early identification of comorbidities must become a standard best practice, as it enables safer, more effective and holistic care. With early identification, we also benefit from more realistic expectations regarding an injured worker’s recovery and return to work,” added Patten. “Employers must analyze how comorbidities are affecting their unique set of claims and develop strategies, including wellness programs, to mitigate the prevalence of these conditions within their workforce.”

The International Foundation of Employee Benefits Plans reports for every $1 spent on wellness, employers can expect to save up to $3 in healthcare costs. Whether wellness programs include bike-to-work, nutritional counseling or weight management initiatives, they can help to reduce the occurrence of comorbidities—such as obesity, diabetes and hypertension—among employees.

Source: One Call Care Management