The Impact of Comorbidities

• Zack Craft – VP Complex Claim | MTI America
• Dr. Mark Glencross – Director of Occupational Medicine | Tampa General Hospital
• Teddy Gonzalez – Vice-President | Field Case Managers
• Dr. Steve Weber – Physician | Orlando Orthopedic Center

Impact on Claims

In a recent NCCI study, the share of workers’ compensation claims with a comorbidity diagnosis nearly tripled from 2.4% to 6.6%. Claims with a comorbidity diagnosis have about two times the medical costs of otherwise comparable claims. Many of the common comorbidities include hypertension, high blood pressure, obesity, diabetes, and depression.

Comorbidity Trends

• Diabetes: 10% of the U.S. population has diabetes with another 3% that go undiagnosed.
• Obesity: 30% of adults over the age of 18  have obesity. Musculoskeletal disorders combined with obesity are the highest predictor of workplace injuries.
• Hypertension: 1 in 3 adults have hypertension.
• Mental health: 50% increase in diagnoses post-pandemic. 1 in 20 adults has a serious mental health problem.

Comorbidity Disability Calculators

The MD Guidelines Population Database includes more than seven million disability leave records, and can be used to establish estimated duration times away from work. For example, based on comorbidities, like obesity, it can predict a 17% increase in duration time away from work for low back pain.

Potential Complications

Comorbidities can cause simple injuries to inflate into infections, extensive surgeries, and even amputations. An injured worker who smokes and is obese will statistically take longer to recover and has a much higher chance of experiencing complications in their recovery process. Diabetes is associated with a need for more attentive wound care and when not taken care of, those can result in amputations. The injured worker has to be motivated in their own care too, which means managing not just their current injury, but pre-existing comorbidities.

Conventional Tactics for Mitigation

Claim Actions

• Identify early in claim
• Nurse case manager awareness
• Physician expert review to determine likely effect on claim
• Referral or consider covering effective treatment
• Periodic physician review for optimizing care

Long-Term Employer Strategies

• Onsite clinic or HRA to detect
• Review group claim data for targeting high-risk groups
• Incentivize wellness participation
• Encourage physical activity
• Optimize healthy choices in cafeteria space
• Bring in expert health educator