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ARC: OBESITY AND WORKERS COMPENSATION: STRATEGIES TO IMPROVE CLAIMS OUTCOMES

Obese workers compensation claimants duration much longer

A study that shows a more than fivefold increase in the duration of workers compensation claims when the claimants are obese will help employers and insurers better manage related costs, experts say.

To date, limited statistical analysis has been conducted on the correlation between increased claims costs and obese claimants, although payers have watched their medical expenses rise along with treating more injured worker comorbid ailments stemming from their growing waistlines.

“It's just not an area where data has been collected (over) a significant period of time,” said Bruce Hockman, executive vp and workers comp practice leader in Philadelphia for Towers Watson & Co.

In research released last week, NCCI Holdings Inc. said the duration of workers comp indemnity benefits paid to the most severely obese workers is more than five times greater than claimants who are not obese but filed comparable claims.

The research and rating organization examined claims provided by insurers operating in 40 states to reach its conclusions.

“The study shows that, based on temporary total and permanent total indemnity benefit payments, the duration of obese claimants is more than five times the duration of nonobese claimants,” NCCI found in the analysis. “When permanent partial benefits are counted toward duration as well, this multiple climbs to more than six.”

NCCI's findings on the effect of obesity on indemnity duration are close to those in a landmark 2007 Duke University Medical School study. The research by the Duke team determined that obese workers file more claims, have higher medical costs and miss more workdays due to job-related injuries than do their nonobese counterparts.

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The Duke University study is widely cited today in discussions and articles on the impact of obesity on workers compensation claims.

While he respects the Duke University study, which was conducted with a “very high-quality” data set, workers comp observers have noted that its findings were based only on claims filed by Duke employees, said Frank Schmid, a director and senior economist for NCCI in Boca Raton, Fla.

NCCI's findings are based on a much more comprehensive data set that confirmed the Duke University results, said Mr. Schmid, one author of the NCCI study.

NCCI reached its conclusions by culling 4.8 million claims, although only 6,435 of those were compared with similar claims with nonobese claimants.

It is important to note that NCCI's results apply to employees who are among the most severely obese, which is similar to the Duke findings, Mr. Schmid said.

The information will help insurers better understand how to accelerate claim reserves when obesity is a factor, Mr. Hockman said.

He also expects it will help employers and insurers better manage medical care at a time when more payers are relying on predictive modeling to point to potential complexities early in the life of a claim.

While data on the impact of obesity on workers comps claims is limited, NCCI's results are not surprising given what is known about its impact on medical care overall, said Dr. Bernyce Peplowski, medical director of California's State Compensation Insurance Fund in San Francisco.

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“If we go back to 1997, most hip and knee replacements (nationwide) occurred in the 65- to 84-year-old age group,” Dr. Peplowski said. “But by 2004, we had a 71% increase in hip replacements among 45- to 65-year-olds and an 83% increase in knee replacements in the 45- to 65-year-old age group.” She said that data reflects the growth in obesity.

At the current growth rate, the number of knee replacements could mushroom to 1.4 million by 2015 from 430,000 in 2004, while hip replacements could jump to 600,000 by 2015 from 225,000 in 2004, she said in citing various nationwide sources.

“Our two medical icebergs...are obesity and advancing age,” Dr. Peplowski said.

Twisted knees are just one example of injuries that may not have occurred had the claimant not been obese, said Tammy Moore, claims manager for third-party administrator Alternative Service Concepts L.L.C. in Nashville, Tenn.

“I would say it's not uncommon at all,” Ms. Moore said.

In addition, she also is witnessing expenses rise as obese patients require weight loss programs prior to surgeries, larger wheelchairs, specialized beds as well as new injuries occurring during the recovery process.

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