Rising Number of Older Workers Brings New Considerations for Insurance Adjusters

The American workplace is undergoing dramatic change from opposite directions: As futuristic innovations such as artificial intelligence permeate operations, our oldest human employees are occupying a greater share of jobs. This dynamic could provide a wonderful combination of new technology and wise counsel. It will also keep workers’ compensation insurance adjusters on their toes, as they will need to remain sensitive to a host of issues that accompany elder workers.

The workforce has grayed considerably. According to the U.S. Bureau of Labor Statistics, 3.2% of workers were over age 65 in 2003. That figure rose to 5.2% in 2013 and 6.7% in 2023. The BLS projects that workers over 65 will make up 8.6% of the workforce by 2033.

A larger share of older adults will be working, too. The BLS predicts labor force participation for people between ages 65 and 74 will increase from 26.9% in 2023 to 30.4 % in 2033. More people older than 75 will also be working, growing their participation rate from 8.3% to 10.1% of their ranks.

The challenge for companies and adjusters is that older workers face a higher prevalence of comorbidities—coexisting health conditions that can complicate their overall health management.

As individuals age, they are more likely to experience multiple chronic conditions simultaneously, such as hypertension, diabetes and arthritis. These comorbidities can lead to increased medical needs and a higher risk of workplace injuries or illnesses, affecting their ability to perform tasks efficiently and safely. Consequently, this demographic may experience elevated workers’ comp claims, as managing these health issues can exacerbate the impact of workplace accidents or injuries. Addressing these challenges requires targeted strategies from employers, including enhanced health management programs and ergonomic adjustments, to support older workers and mitigate the risks associated with their complex health profiles.

An article from the Centers for Disease Control and Prevention noted that survey respondents between 55 and 64 years olf reported the highest rate of work-related health issues (41.3%), nearly twice that reported by those ages 18 to 24 (21.7%).

Injuries in older workers tend to be more severe and require longer recovery times compared to younger workers. In 2023, Traveler’s Insurance reported that total costs for employees ages 60 and older were nearly 15% higher than for employees between the ages 35 and 49 and 140% more than those between 18 and 24 years old.

An article on the retirement site Rethinking65 quotes Rich Ives, Travelers’ vice president of business insurance claims, stating, “If you have a comorbidity, the cost of your claim is twice as much. … If you have two or more comorbidities, the cost of your claim is fivefold. That’s regardless of age.” However, as the study points out, older workers are more likely to have such preexisting conditions; therefore, their medical bills are likely to be higher.

Adjuster Considerations

Handling claims of injured older workers requires adjusters to navigate several considerations to ensure fair and effective outcomes. Key factors adjusters should keep in mind include:

• Age-Related Health Issues: Because older workers are more likely to have preexisting health conditions or age-related impairments (arthritis, reduced bone density) that can complicate injury claims, adjusters should carefully assess their medical history. Prior medical records should be obtained and examined as early as possible to determine how any preexisting conditions may impact recovery and return-to-work timelines. That means requesting any post-hire medical questionnaires from the employer, obtaining a signed medical release from the employee, and completing a medical canvass and/or Insurance Services Office (ISO) claim search at the outset of a claim.
• Delayed Recovery: Adjusters should acknowledge that recovery times for older workers may be longer due to reduced healing capacity and slower rehabilitation. Adjusters should set realistic expectations for recovery periods and work closely with treating providers to understand the extent of the injury and anticipated recovery trajectory. Likewise, adjusters should consider setting aside their reserves appropriately on a claim involving an older worker, especially once a preexisting condition or comorbidity is discovered.
• Functional Limitations and Accommodations: Aging can lead to decreased physical abilities, such as reduced strength, flexibility and endurance. Adjusters should consider how these functional limitations affect the injured worker’s ability to perform their job duties and whether accommodations or modifications are necessary. Adjusters will need to work closely with the insured to explore potential job modifications or alternative tasks that align with the injured worker’s capabilities post-injury and ensure that modified duty is available and offered whenever possible.
• Psychosocial Factors: Older workers may face unique psychosocial challenges related to a work injury, such as concerns about retirement, financial stability or loss of job skills. Adjusters will need to approach these cases with empathy and consider how these factors may impact the injured worker’s recovery, compliance with medical treatment and willingness to return to work.
• Communication and Documentation: Clear and frequent communication with all involved—including the injured worker, medical providers, employers and legal representatives—is essential. Adjusters should document all interactions and decisions thoroughly to ensure transparency and compliance with state and federal laws.
• Legal and Regulatory Compliance: Familiarity with the Americans with Disabilities Act (ADA) and workers’ compensation regulations is critical. Adjusters must ensure decisions regarding benefits, medical treatment and return-to-work accommodations adhere to legal standards and promote equitable treatment for older workers. Inevitably, adjusters must also consider Medicare implications when handling claims involving older workers. Due to Medicare Secondary Payer (MSP) rules, adjusters will need to coordinate benefits appropriately to avoid improper payments and potential Medicare recovery actions. This will include reporting claims to Medicare when they involve a Medicare beneficiary; coordinating payments to prevent double payment issues; and notifying Medicare of settlements, judgments, awards or other payments to ensure that Medicare’s interests are protected. Of course, obtaining Medicare Set-Aside Arrangements (MSA) will be required in some cases, which will contribute to additional claims costs and possibly impact overall settlement amount. By proactively addressing these factors, adjusters can ensure compliance, facilitate timely claims processing, and protect the interests of both injured workers and Medicare.

When adjusters integrate the above considerations into their approach, they can effectively manage claims involving injured older workers, promote equitable outcomes and potentially minimize claims costs while supporting the aging worker’s journey towards recovery and return to work.

Cumbermack has provided litigation counsel and representation in workers’ comp matters for more than 20 years on behalf of employers, insurance companies, self-insureds and third-party administrators in Florida and Georgia. She is a partner and chief of diversity at Swift Currie McGhee & Hiers in Atlanta.