Comorbidities double Workers’ Comp claims costs

The number of Workers’ Comp claimants suffering from comorbidities has nearly tripled in recent years and related claim costs are about twice the medical costs of comparable claims, according to a recent study by the National Council on Compensation Insurance, Inc. (NCCI). And while most claims are medical only, about 50% of those with a comorbidity diagnosis are lost-time, While disturbing, the results are not surprising given the percentage of employees who are obese or have chronic health conditions such as diabetes, hypertension, asthma, and so on. The report also had troubling news about claims and drug abuse – from 2000 to 2009 the share of claims with a drug abuse diagnosis, including alcohol and tobacco, more than quadrupled.

The NCCI research brief titled “Comorbidities in Workers Compensation,” also reviews a wide range of issues such as the role of gender, the association of comorbidities with injury types, and the increase in medical services necessary when specific comorbidities accompany a claim.

Lessons learned:
There is a link between employee health and profitability.A healthier workforce lowers direct costs such as insurance premiums and Workers’ Comp, reduces absenteeism and improved productivity. Wellness initiatives, workplace changes that promote physical activity, good nutrition and smoking cessation are key. While employers do not have access to specific employee health records because of federal privacy laws, proactive employers are tapping aggregate data from insurance companies to better understand the chronic conditions that exist in their workforce, how often employees use expensive emergency services and other cost drivers. With this information they can understand their spending and figure out what health plan design is best for the work force.

Employers implementing wellness initiatives, workplace changes that promote physical activity, good nutrition and smoking cessation have seen a positive ROI. With major changes in the employer health insurance market set to take place in 2014, as part of the Patient Protection and Affordable Care Act (PPACA), the U.S. Department of Health and Human Services on Nov. 20 announced a series of proposed rules under the Patient Protection and Affordable Care Act governing employee wellness programs and essential health benefits for certain employers.

by Shaun Ideus. Unico Group, Inc. 402.434.7205.