NCCI Study Reveals Obesity Risks in Work Comp

Obesity is growing globally, with America leading the way. In the United States, the incidence of obesity is the highest of all reporting countries and the trend continues unabated. Research conducted by the Centers for Disease Control and Prevention over the past several decades shows:

• In 1990, among states participating in a survey, 10 states had a prevalence of obesity less than 10 percent, and no states had prevalence equal to or greater than 15 percent

• By 1999, no state had prevalence less than 10 percent, 18 states had a prevalence of obesity between 20 percent–24 percent, and no state had prevalence equal to or greater than 25 percent

• In 2009, only one state (Colorado) and the District of Columbia had a prevalence of obesity less than 20 percent. Thirty-three states had prevalence equal to or greater than 25 percent; nine of these states had a prevalence of obesity equal to or greater than 30 percent.

Intuitively, the implications of this trend for workers' compensation are disturbing, and recent research confirms anecdotal data that work-related injuries are far more costly if the injured worker is obese. Furthermore, the dramatically higher medical costs suggest that the types and nature of injuries sustained by obese workers, especially the morbidly obese, are more likely to result in permanent disabilities.

A new study by the National Council on Compensation Insurance (NCCI) advances this research by analyzing the differences in outcomes between workplace injuries with obese and non-obese claims. (Obesity is generally defined as having a body mass index of 30 or more. Morbid obesity is generally defined as having a body mass index of 40 or more. However, in general, workers' compensation claims data typically does not capture weight, height, or body mass index information. Therefore, in this study, claims were categorized as obese when a medical provider includes on the billed medical transaction a diagnosis code indicating obesity.)

The NCCI paper, “How Obesity Increases the Risk of Disabling Workplace Injuries,” reports on differences in injury types and treatment patterns between a sample of more than 7,000 claims with obesity as a secondary diagnosis and another 20,000 claims with virtually identical characteristics — primary diagnosis, gender, industry group, year of injury, state, and approximate age — but no obesity diagnosis.

Key Findings
The study concludes that there are systematic differences in the outcomes for obese and non-obese claimants with comparable demographic characteristics. The study also concludes that there is greater risk that injuries will create permanent disabilities if the injured worker is obese.

Case studies indicate that, in general, even when both the obese claim and non-obese claim are the same injury type, the range of medical treatments, costs, and duration typically is greater for obese claimants. (These examples, however, also indicate that there is considerable variation at the individual claim level and that in some cases the non-obese claim may be more costly.)

Case Studies
For the case studies examined, treatment categories that tended to be the primary cost drivers included physical therapy, complex surgery, and drugs and supplies.

In one case study, two claims were submitted for “Lower Leg Injury Not Otherwise Specified.” Both claims were medical only and the obese had significantly more treatments and costs. The non-obese claim was treated only with an office visit, two X-rays, and a drug or supply the day after the injury, while treatments for the obese claim occurred over a period of more than 200 days after the injury. In total, the obese claim had more than 10 times the number of treatments than the non-obese claim had.

Another study, this one involving two claims of “Sprain of Shoulder/Arm Not Otherwise Specified”, compared a non-obese medical-only claim and an obese permanent partial claim. The obese claim was significantly more costly due to an entire range of treatments including physical therapy and complex surgery that the non-obese claim did not incur. Essentially, the non-obese claim had only an office visit, X-ray, and drug treatment the day of the injury and a follow-up office visit the next day. In total, the non-obese claim had four treatments, while the obese claim had more than 75. A major cost driver for the obese claim was complex surgery.

Harry Shuford is a practice leader and chief economist with NCCI. Tanya Restrepo is an economist.