Health care organizations are already contending with workforce shortages, high burnout and aging personnel. (Adobe Stock)

Last year, I wrote about the Silver Wave, or the growing influx of older professionals into the health care workforce, and how this trend is forcing health care leaders to rethink everything from workforce planning to risk management.

That wave has not crested. In fact, it’s surging, and now, a new legislative threat has emerged that could drown hospital systems already battling shrinking margins and workforce shortages.

A proposed California bill seeks to create a presumption that musculoskeletal injuries (MSDs) sustained by hospital workers are work-related for the purposes of workers’ compensation. If enacted, this would shift the burden of proof away from the employee and force hospitals to accept claims without needing to demonstrate that the injury occurred on the job.

This isn’t just a procedural change. It’s a tectonic shift in liability, and one with billions of dollars on the line.

Why it matters

Health care organizations are already contending with workforce shortages, high burnout and aging personnel.

Now, with presumptive eligibility for MSDs on the table, the financial burden could rise sharply. According to the California Hospital Association, if enacted, this bill could:

  • Cost the system $1.5–$2.5 billion annually
  • Result in hundreds of thousands of dollars per individual case
  • Waive traditional evidence requirements, making it difficult for hospitals to challenge or investigate claims

It’s important to note: Hospitals are already approving the vast majority of workers’ comp claims. The California Workers’ Compensation Institute reports that over 90% of claims filed in hospital settings are accepted under current processes. There is no pattern of abuse or denial.

The real issue? This legislation would create a system in which liability is presumed, not proven. That change will cripple operational budgets.

The impact on aging workers

Musculoskeletal injuries are the most common cause of lost work time in health care, particularly in roles like nursing, patient transport, emergency rooms and physical therapy. These injuries are inherently linked to cumulative wear and tear; age is clearly a major factor.

According to recent data:

  • Workers aged 60 and older have experienced the highest increase in workers’ compensation claim frequency from 2020 through 2024
  • Their claims are more likely to result in longer disability durations, greater medical complexity, and higher average costs

The aging of the workforce is well-documented. Per the 2024 State of the U.S. Health Workforce Report:

  • Nearly 1 in 3 registered nurses is over age 50
  • About half of U.S. physicians are over 55

Presumption laws, in effect, shift the risk burden of this demographic trend entirely onto hospitals—without additional funding or operational relief.

Hospitals can’t afford it

The financial health of California hospitals is already on the brink. Many facilities, especially in rural and underserved areas, are operating in the red. According to recent reporting from the California Hospital Association, over 50% of hospitals statewide ended 2023 with negative margins, driven by labor costs, inflation, and stagnant reimbursement rates.

Layering a new, unfunded mandate on top of these conditions isn’t just unsustainable; it’s dangerous.

The result could be:

  • Service cutbacks;
  • Delayed capital improvements;
  • Further staffing reductions; and
  • Greater financial inequity between large systems and community hospitals.

Unintended consequences of presumption

While the goal of protecting aging workers is valid, presumption laws often lead to unintended side effects:

  • Increased claim frequency — not necessarily due to fraud, but due to the difficulty of distinguishing workplace-related strain from pre-existing conditions;
  • Decreased employer control over claims management and return-to-work timelines;
  • Erosion of safety investments, since claims will be approved regardless of program quality or documentation; and
  • Reduced focus on prevention, as liability becomes automatic instead of evidence-based.

A more balanced path forward

Rather than blanket presumptions, we should be investing in sustainable, data-driven solutions that truly support the aging health care workforce while maintaining operational stability. That includes:

  • Proactive ergonomics and injury prevention programs, including safe patient handling, redesigned workstations, load-lifting assistance and targeted wellness programs;
  • Predictive analytics to track MSD claims by role, tenure, and age group, enabling smarter planning;
  • Custom-designed workers’ comp programs that reward prevention and support claims advocacy;
  • Return-to-work infrastructure that reintegrates older workers through modified duties and remote options; and
  • Collaborative policy-making that aligns public health goals with financial sustainability.

These strategies don’t just reduce costs; they promote long-term workforce resilience.

Final thought

The aging workforce isn’t going away. In fact, it may be the defining factor in how we shape the future of health care operations and risk management.

But legislating away the complexity through presumptive liability is not the answer. If we want to protect our health care heroes while preserving the viability of the systems that support them, we need smart, scalable, and strategic solutions. Not shortcuts.

Let’s advocate for the full picture!

Tim Mooney is senior vice president and national Health Care Services Practice Leader at The Liberty Company Insurance Brokers. This article is published with permission from the author and may not be reproduced.

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