Filed Under:Markets, Workers Compensation

New research shows impact of underlying conditions on workers’ compensation claims

The workers' compensation industry needs to do a better job of managing underlying chronic conditions along with an employee's injury in order to better manage claims costs, research shows.. (Photo: iStock)
The workers' compensation industry needs to do a better job of managing underlying chronic conditions along with an employee's injury in order to better manage claims costs, research shows.. (Photo: iStock)

Claims involving comorbidities are often associated with higher costs and increased duration, but the latest research from Harbor Health Systems undeniably demonstrates the impact comorbidities have on claims outcomes. Based on this research analyzing more than 7,000 workers’ compensation claims, claims associated with comorbid conditions experienced longer claims duration, higher medical costs, more temporary total disability (TTD) days and increased litigation and surgery rates. These findings were recently presented at the National Workers’ Compensation & Disability Conference (NWCDC), in New Orleans, Louisiana.

The research study evaluated the following seven comorbidities in claims with an injury date between January 1, 2011, and December 31, 2013: obesity, diabetes, hypertension, addiction, mental health, tobacco use and multiple comorbidities.

Impact by the numbers

By examining these seven comorbidities, the research found significant impacts on total claims costs, total medical costs, claim duration, TTD days, litigation rates, recidivism and surgery rates:

  • Claim duration is significantly longer for the claims involving comorbidities with the exception of tobacco claims. Claim duration increased by 76 percent for claims involving multiple comorbidities; 67 percent for claims involving addiction and 55 percent for obesity-related claims.
  • Incurred total costs increased 341 percent with multiple comorbidities.
  • Claims in all the comorbidity groups had significantly higher TTD days compared to the control group. TTD days increased by 285 percent for multiple comorbidities claims and 274 percent for addiction-related claims.  
  • Litigation rates also increased when claims involved multiple comorbidities, mental health or addiction. Litigation rates for claims with multiple comorbidities increased approximately 147 percent; 224 percent for addiction-related claims and 248 percent for mental health related claims.
  • Surgery rates increased 123 percent for claims involving multiple comorbidities and 140 percent for claims involving obesity.
  • Tobacco use did not have a significant impact on the outcomes compared to the control group.

When evaluating the overall impact of various comorbidities on workers’ compensation claims, the two 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.  

Links between comorbidities complicate risks

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.

Given these findings, the workers’ compensation industry needs a more comprehensive, system-wide approach to address the risk associated with comorbidities. Prescriptive solutions ranging from more complete intake data, to a system that incorporates comorbidities into the utilization review process, to factoring in comorbidities in the treatment process should be all be considered.

By keeping these comorbid conditions top of mind in claims management, workers’ compensation professionals can minimize risk while providing more appropriate care to injured workers.

Linda Lane is president of Harbor Health Systems, a One Call Care Management company. She can be reached at Llane@Harborsys.com.

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