A new California Workers’ Compensation Institute (CWCI) report suggests that the number of work injury claims involving obesity could increase sharply, along with the associated costs, following the recent vote by the American Medical Association (AMA) to reclassify obesity as a treatable disease.
In mid-June, the AMA approved a resolution reclassifying obesity as “a disease state,” effectively declaring that one third of all Americans suffer from a medical condition that requires treatment, a move that is widely expected to increase pressure on doctors to address the condition when treating obese patients, and on health care payers to pay for obesity consultations and treatment. In workers’ compensation, obesity has historically been a co-morbidity – a condition that occurs at the same time, but usually independent of, an injury or illness. In the past, a medical provider might include an obesity co-morbidity code on their medical bill if they felt the condition needed to be addressed so that the work injury could be treated and the patient could recover and return to work (e.g., if an obese injured worker needed to lose weight before they could have back surgery.) Even as a co-morbidity, however, obesity in workers’ compensation has gone largely unreported. A CWCI survey from 2011 found that even though 28% of injured workers reported that they were obese, only 0.9% of the job injury claims from those workers included an obesity co-morbidity diagnostic code, indicating that obesity has only infrequently been deemed a condition that needed to be addressed in order to treat most work injuries and illnesses. That may change, however, if medical providers feel a greater responsibility to counsel obese patients about their weight and to treat the condition, especially if there is a greater likelihood that they will be paid for doing so. That could prompt an influx of claims that include obesity as a co-morbidity, as well as an increase in cases in which obesity is claimed as a compensable consequence of injury (e.g., when an injured worker gains weight due to lack of exercise or a medication prescribed to them during recovery).
Because the number of claims in which obesity is treated could increase sharply from current levels, CWCI undertook an analysis to better understand differences in claim characteristics and outcomes for workers’ comp cases with and without obesity as a co-morbidity, and to establish a baseline for measuring the impact of the recent reclassification on California workers’ compensation. Using data from 1.2 million claims from accident years 2005 to 2010, the Institute found that claims with an obesity co-morbidity have had significantly higher rates of lost time from work, permanent disability, and attorney involvement, and have been much more likely to involve additional co-morbidities such as arthritis, hypertension and mental health issues, as well as prescriptions for opioid painkillers and psychotropic drugs – all of which are associated with higher claim costs. Indeed, after case-mix adjustment, the study found that paid losses on claims with the obesity co-morbidity averaged $116,437, or 81.3% more than those without; and that these claims averaged nearly 35 weeks of lost time, or 80% more than the 19 week average for claims without the obesity co-morbidity. The Institute notes that to the extent that such differences continue in the future, these results suggest that any increase in the number of job injury claims in which obesity is treated could have significant cost implications for workers’ compensation.
The Institute has published the analysis, with additional background, data and graphics, in a research report, “Obesity as a Medical Disease: Potential Implications for Workers’ Compensation,” which is posted in the Research section of the Institute website, www.cwci.org. CWCI members and subscribers may access a summary Bulletin by logging in to the Institute’s website, www.cwci.org.