The Impact of Comorbidities on Workers’ Compensation

Topics: Loss Control

Summary: Following a workplace injury or illness, comorbidities like diabetes, arthritis and others can affect an employee’s recovery, return to work and overall productivity. In this article, we’ll look at some common comorbidities, their impact on workers’ compensation claims, and offer some tips employers can utilize to help improve employee wellness.

Comorbidities and the Risk Factors for Employee Wellness

A healthy workforce is vital to an organization’s everyday operations. After an employee suffers a work-related injury or illness, ensuring their successful recovery and safe return to the workplace should be top of mind for employers.

However, for some individuals, a smooth return to work can be complicated due to comorbidities, or certain existing medical conditions, that can affect their treatment plan and recovery – and even their overall wellness and quality of life.

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What are Comorbidities?

Comorbidities are defined as chronic health conditions that are experienced simultaneously. Some common examples of comorbidities include:
  • Obesity
  • Arthritis
  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
  • Diabetes
  • Hypertension
  • Depression and anxiety
Comorbidities are generally long-term health conditions that can increase the severity of other illnesses or injuries. The Centers for Disease Control and Prevention (CDC) reports that almost 52% of Americans have been diagnosed with at least one of 10 chronic conditions.

Having one chronic health condition can often lead to an increased risk of developing another, such as diabetes, arthritis, obesity and hypertension, resulting in more costly workers’ compensation claims. For example, diabetes and obesity are often closely related, as diabetes is a common condition for an obese individual. If an obese worker is injured on the job, they are likely to miss 13 more days of work than someone who is not obese. If that worker also has diabetes, they could face an even lengthier recovery time, especially following a surgery, as those with diabetes often experience poor wound healing.

Why do Comorbidities Affect Workers’ Compensation Claims?

Chikita Mann, MSN, RN, CCM and Case Manager for AmTrust Financial, provided the following scenario in an issue of Care Management:

A 55-year-old male warehouse worker falls while he is at work and sustains an ankle fracture. When he is taken to the emergency department, diagnostic laboratory values reveal a blood sugar level of 350 mg/dL and preexisting arthritic changes in his ankle. He weighs over 250 pounds. During the intake interview, it is discovered that he has known for the past two years that he has diabetes, but he has not been receiving treatment for it. He also does not have a primary care physician, and he has been having issues with foot ulcers.

According to Mann, these types of scenarios are becoming the norm for work-related cases, especially as chronic medical conditions continue to rise in the United States. A rapidly aging population, poor nutrition, a lack of physical activity and increased life expectancy are all reasons we are seeing a rise in chronic conditions throughout the country.

What impact do comorbidities have on workers’ compensation claims? When an employee is injured or ill, any comorbidities they may have will contribute to reduced work productivity in both absenteeism (habitual lost time from work) and presenteeism (reduced productivity on the job). While time out of work has an obvious effect on productivity, Mann states that research proves presenteeism costs organizations more than $150 billion annually.

Research from the National Council on Compensation Insurance (NCCI) shows that workers’ compensation claims involving comorbidities have almost tripled since 2000. When a claim involves a chronic illness, it’s likely to cost around twice as much as a comparable claim that does not include comorbidities. For example, in the scenario above, people with diabetes and foot ulcers often have an increased risk of falls and subsequent fractures, and diabetes can lead to a longer recovery period for the employee. Following a workplace injury, an individual with comorbidities could need more time to heal, or they might develop additional complications. The employee could even be at risk for permanent disability.

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How to Improve Employee Wellness and Reduce Workers’ Comp Costs

AmTrust’s Melissa Burke, VP and Head of Managed Care and Clinical, says, “When an injury occurs, the employer needs to continue fostering an environment where employees know their well-being matters. Keep in contact and check in on your injured employees. Help support their return to work by making sure they don’t feel isolated or alone.”

Burke adds, “Comorbidities can be both physical and psychological. We try to take that holistic approach to the recovery plan. Sometimes an individual might be healed physically, but if they aren’t ready mentally to come back to work, we look into services that can help, such as telemedicine. At AmTrust, our goal is to customize the approach for each injured employee, to make sure they have the support and resources they each need for a safe return to work.”

Studies show a direct correlation between effective employee wellness programs and reducing workers’ compensation and disability management claims by 30%. Healthy employees who experience on-the-job injuries can recover faster than those with chronic medical conditions. Make sure to prioritize employee wellness to help them reduce the risk of developing comorbidities.

Employers can work with their loss control team and human resources department to create a wellness program that considers employee health and workplace safety.

A robust wellness program can include:
  • Offering preventive health screenings free of charge
  • Providing on-site wellness activities like walking groups, free yoga classes or health education classes
  • Offering a discount for local gyms or an on-site fitness center
  • Encouraging employees to make healthy lifestyle choices through better nutrition and increased exercise
Additionally, if an employee is injured in the workplace, make sure to screen for comorbidities at the time of the injury. A nurse case manager with experience in identifying comorbidities can be assigned to the case to determine if there are preexisting conditions that could affect the employee’s recovery time.

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Loss Control Services from AmTrust Financial

AmTrust’s Loss Control Department offers a variety of workplace safety resources to ensure employers understand how to provide a safe, healthy work environment for their employees and reduce workers’ compensation claims. From industry resources to streaming training videos on a variety of topics, we are here to help protect your company’s most valuable asset – your employees. For more information about our loss control services, please contact us today.

This material is for informational purposes only and is not legal or business advice. Neither AmTrust Financial Services, Inc. nor any of its subsidiaries or affiliates represents or warrants that the information contained herein is appropriate or suitable for any specific business or legal purpose. Readers seeking resolution of specific questions should consult their business and/or legal advisors. Coverages may vary by location. Contact your local RSM for more information.

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