Comorbidities and workplace injuries: Three ways to improve outcomes

The path to recovery after a workplace injury is not always a straight line. A workers’ compensation claim can become increasingly complex due to common health conditions and comorbidities. While comorbidities are often pre-existing and not directly included in a claim, they can have a significant impact on claim costs and the injured employee’s recovery.

The latest statistics illustrate this growing concern.

One in every three American adults is reported to have high blood pressure. [1] Diabetes affects 30.3 million Americans [2], while obesity affects 39.8% of adults in the U.S. [3] Depression is the leading cause of disability in the U.S. for people ages 15-44; 6.7% of American adults are estimated to exhibit depression symptoms [4], which can often be exacerbated by injuries that keep an employee off work for an extended period of time. An aging workforce is also contributing to an increase in comorbid conditions among workplace injuries. According to projections by the U.S. Bureau of Labor Statistics, by 2020, one in four workers will be considered “older workers.” This is an increase from one in seven in 2000. As the workforce ages, conditions such as hypertension, diabetes, obesity and depression increase, as well.

Employers may think there isn’t much they can do about increasing comorbid conditions in their workforce. However, we can’t ignore the fact that these conditions can have a significant impact on claims, including increasing costs and delaying or preventing recovery. According to a 2016 Harbor Health study, claims with comorbidities experienced a 76% increase in claim duration, a 341% increase in incurred costs, and a 285% increase in temporary total disability (TTD) days.

To illustrate the point, we can use the Official Disability Guidelines calculator to examine the recovery time for a 32-year-old female with a common shoulder injury. With no other health issues present, the anticipated recovery time would be 35 days best practice and 55 days typical. However, if the injured employee also has diabetes, her recovery time increases to 80 days. Add hypertension to the mix and her recovery time skyrockets to 103 days, almost tripling the best practice estimate.

Here are three key steps employers can take to help improve claim and recovery outcomes for injured employees with comorbidities.

  1. Encourage employees to manage any conditions they have through employee wellness programs. These programs can help by promoting healthy habits and improving overall well-being. This means that if employees get hurt on the job, comorbidities are less likely to have a significant impact. One caveat – it is important that the wellness programs target the right population and not just those who are already healthy.
  2. Screen employees for comorbidities at the time of injury. If an employer uses a nurse triage service, make sure the nurse is asking about any pre-existing conditions at the start, so discussions around controlling comorbidities can occur early in the claim. The nurse can even refer the injured employee to the employer’s wellness programs as an option to manage their condition.
  3. Ensure the nurse case managers you work with are skilled at identifying comorbidities and other conditions that can impact the injured employee’s recovery. Not all workers know they have a condition. In fact, 7.2 million Americans are estimated to have undiagnosed diabetes. [2] This means the nurse may have to do some digging to uncover factors that could be contributing to the employee’s symptoms.  This can help ensure that employers aren’t paying for medical costs unrelated to the injury and provide an opportunity to manage the condition to help speed the employee’s recovery and return to work.

With these steps, you can make a difference.

Here’s one real-world example: Mr. Jones, who was involved in an automobile accident at work, was seen at an urgent care center for low back pain and three days later, he reported increased pain that radiated down to his legs and feet. He also had visual disturbances, bilateral numbness and tingling in his fingers, and blurred vision in both eyes. The case manager assessed that Mr. Jones was obese and had a history of hypertension, putting him at risk for diabetes as well. The nurse asked the treating provider to perform a blood glucose test at Mr. Jones’ next visit to determine if diabetes, and not the accident, could be causing his symptoms. The test revealed that he indeed had uncontrolled diabetes that led to peripheral neuropathy. Mr. Jones was counseled about managing his diabetes and placed on medication to help control his blood sugar, all of which was handled outside of his workers’ compensation claim. Through skilled clinical analysis, the nurse identified the root cause of his symptoms, which addressed his potentially life-threatening diabetes and allowed him to return to work.

While comorbidities are becoming more prevalent and can complicate a claim, taking the steps above can make all the difference. By focusing on the employee’s overall well-being, we can help them improve their health and recover from their injury so they can return to work as quickly and safely as possible.

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