Workers’ Compensation Costs May Rise after Obesity Classified as Disease

Workers’ Compensation Costs May Rise after Obesity Classified as Disease

The American Medical Association’s recent decision to reclassify obesity as a treatable disease may have serious repercussions for workers’ comp claims costs, according to a new report. While obesity itself in most cases will not be compensable as a workplace illness, the condition will certainly play a role in the way obese claimants receive medical treatment. And it could result in obesity being considered an outgrowth of the original workplace injury if an injured worker gains weight during rehabilitation.

According to the California Workers’ Compensation Institute, obesity may be deemed “a compensable consequence of injury, just as sleep disorders, sexual dysfunction and psychological disorders became common workers’ compensation ‘add-ons’ prior to passage of last year’s workers’ comp reforms.” “For example, this could be the case in claims where the employee remains off work and gains weight after being inactive for extended periods, or where they are treated with drugs that cause weight gain,” the institute wrote Not only that, but workers who gain weight in sedentary jobs, such as long-haul trucking or desk jobs that require an individual to remain seated for extended periods of time, may also file workers’ compensation illness claims, the Institute wrote in its report.

“In such scenarios the viability of the claim would likely hinge on proving that the work actually caused the obesity, which would be an issue ripe for dispute and which could lead to additional litigation,” the institute wrote. “In light of the increasing evidence of genetic predisposition for various medical conditions, defining causation and relative causation will be critical in claims involving obesity, and also may arise in other employment areas such as pre-employment screening.”

The change may end up significantly increasing the costs of claims for workers’ comp claimants who are already obese. And such claims are already expensive, according to the institute. The definition of obese is someone who has a body-mass index of 30 or more, and 35.7% of U.S. adults fall into this category. BMI is measured as a ratio of your weight to your height (weight divided by height). It is an imperfect measurement, as muscular individuals and athletes may tend to have higher BMIs and may not be considered overweight or obese. To date, obesity in workers’ compensation claims has been treated as a “co-morbidity” – a condition that occurs at the same time, but is typically independent of the work-related compensable injury or illness. “For example, obesity as a comorbidity within a workers’ compensation claim can complicate the treatment of a compensable back or joint injury,” wrote the institute. An earlier study by the institute of claims filed between 2005 and 2010 found that claims with obesity as a comorbidity have had significantly higher rates of lost time from work, permanent disability and attorney involvement, and have been much more likely to involve additional comorbidities and prescriptions for opioid painkillers and psychotropic drugs.

The study found that of claims with obesity as comorbidity: 

  • 24% were for back problems with spinal cord involvement, compared to 14.1% for claims without obesity as a comorbidity,
  • 10.8% were for degenerative or infective joint disorders, compared to 2.5%, 
  • 6.7% were for spine disorders, compared to 1%,
  • 3.1% were for hernias, compared to 0.6%,
  • 3.1% were for carpal tunnel syndrome, compared to 0.6%.

Claims with obesity as a comorbidity:

  • Had average medical payments of $68,468, compared to $35,091 for those without;
  • Had average indemnity (wage replacement) payments of $47,970, compared to $29,140 for those without; and 
  • Averaged 35 weeks of lost time, or 80% more than the average of 19 weeks for claims without the obesity comorbidity. 

Keep in mind that these costs were for workers’ compensation claims filed when obesity was not classified as a disease by the American Medical Association.  “To the extent that such disparities continue in the future, these results suggest that any increase in the volume of claims involving obesity treatments could have a significant impact on workers’ compensation payments,” the institute wrote.

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