Workers Comp Contemplates Co-Morbidities
Claims managers in workers comp face an ongoing challenge: how can you help an injured worker get better if personal health problems stand in the way of recovery? For example, how can you surgically repair the knee of an obese worker, or prevent infection in the wound of a worker with uncontrolled diabetes? How can you repair the back of a chain smoker, whose compromised lung function will likely undermine recovery?
While it may not be a national trend, there is a movement to include treatment of co-morbidities as part of the workers comp claim strategy. We read in WorkCompCentral (subscription required) that claims professionals are beginning to confront this conundrum. Harry Anderson, a nurse case manager and vocational counselor for New England-based Windham Group, looks at co-morbidities as an essential part of his approach: in speaking of supporting smoke cessation treatment for an injured auto mechanic, Anderson notes that "while it's an added cost to the claim, it lessens the time the person is out of work. Ultimately, it saves money."
Once the carrier opens the door to treating co-morbidities, the question becomes how much treatment, for how long. For example, NCCI has shown that a diagnosis of obesity doubles the medical costs of treatment (PDF). While weight reduction for a morbidly obese worker would be helpful, how far should the carrier go? Should they pay for surgical intervention? What if the worker has no interest in losing weight? There are no easy answers here.
In the case of uncontrolled diabetes, however, the cost-benefits of treatment are clear. When the diagnosis of diabetes occurs at the time of injury (a not uncommon occurrence), educating and treating the worker is key to controlling the cost of the claim. In the absence of personal health insurance, the comp carrier can support relatively inexpensive interventions that will significantly increase the effectiveness of conventional treatments for the injury. Comp coverage of a glucose monitor and a few sessions of nutritional counseling will lead directly to better outcomes.
As health insurance coverage expands under the Affordable Health Care Act, comp carriers will be able to coordinate payment for treatments through primary care physicians. But one way or another, confronting personal health issues should become a basic focus of comp claims management. It may be technically feasible to isolate work-related injuries from co-morbidities, but in the long run, carriers are better off treating the whole person.
Senior Workers Compensation Consultant