Pre-Existing Conditions Weigh 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.

Employees with pre-existing health issues like hypertension, obesity and mental health spend 60% more time recovering from workplace injuries than healthy workers, according to a study by Newport Beach, CA-based Harbor Health Systems.

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, according to the industrial injury clinic’s analysis of 7,000 injured worker cases it handled.

The longer it takes for a worker to recover and return to work, the more expensive the claim becomes, which can affect the employer’s future workers’ comp premiums.

The findings illustrate the importance of trying to keep your employees healthy through wellness programs and access to health insurance to control their conditions.

The study looked at seven comorbidities:

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

Shocking 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 rose by 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 are 147% higher compared to claims with no comorbidities.
• Litigation rates for claims of injured workers with an addiction are 224% higher.
• Litigation rates for claims of injured workers with mental health issues are 248% higher.

The takeaway

You can encourage your 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 for injured workers with these comorbidities.