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Learning early that a workers compensation claimant is obese can help mitigate related health conditions and achieve a successful return to work for the employee.
Despite the fact that one in three U.S. adults is obese, claims adjusters often do not ask claimants about their height and weight during the initial intake process of a claim, employers and consultants say.
Such information can help make an early determination of the appropriate treatment for an injured employee who is obese and likely to suffer from related comorbid conditions that often exacerbate claims costs and injury durations.
The goal is to help claimants become healthy and get back to work, said Charles F. Martin, managing director in the risk consulting practice at Marsh USA Inc. in Norwalk, Conn.
Helping them achieve that, though, requires learning about the injured worker's health conditions “up front,” because the claims management and medical treatment patterns likely differ for an obese person suffering from related comorbid medical conditions, such as diabetes, Mr. Martin said.
“When you have an obese person, you have to pay more attention to the situation because the healing is going to be slower, the cost of the claim is going to be more expensive,” Mr. Martin said. “The more you know, the better you can deal with it if you do have a problem. But if you don't know about the problem for six months, you have just exacerbated the whole thing.”
Apart from addressing related health problems as early as possible, few options may exist to mitigate additional expenses that accompany such claims, several sources said.
According to Boca Raton, Fla.-based NCCI Holdings Inc., injuries sustained by obese workers are more likely to be permanent disabilities. In addition, the range of medical treatments and costs generally are greater for obese claimants.
For example, an NCCI case study comparing an obese with a nonobese worker, both of whom suffer from similar lumbar disc displacement injuries as well as spinal cord disorders, revealed that the final treatment for the nonobese claimant occurred about one year after the injury date. The claimant also received about 100 treatments.
In contrast, the obese claimant received treatments more than four years after the injury date and about 400 treatments in total, including complex surgeries, drugs and physical therapy.
To help injured workers and control costs, insurers could collect claimant height and weight data, NCCI suggested in a 2010 research brief.
“If the data is available, insurers could be aware up front if obesity is likely to be an issue and try to improve the outcome for the injured worker and their family by keeping the claim from becoming a permanent injury and...reducing duration,” NCCI said. “Depending on the added costs in terms of managing these claims, it may also reduce overall claims costs.”
NCCI said insurers could help with programs that improve lifestyle choices in areas such as nutrition and fitness.
While referring obese claimants to employer-sponsored wellness or disease management programs may help some employees lose weight and mitigate their comorbid conditions, such programs are most helpful before an injury occurs and only when employees are motivated to improve their health, sources said.
“Post-injury, there is very little we can do,” said Peggy Crook, director of global claims risk management services for Hilton Worldwide Inc. “You take the injured employee as you find them.”
Workers comp boards in various states have required Hilton to pay for programs that are necessary before an injured employee can undergo surgery for certain workplace injuries, she said.
“There are instances where they can't have the surgery because of the weight,” Ms. Crook added. “So you wind up with a different kind of injury, one that can't be fixed.”
She said she has not yet studied the cost impact of obesity on claims by Hilton employees, in part because other workers comp cost drivers are taking priority.
In addition, Hilton's third-party administrator's claims handlers do not consistently ask about claimants' height and weight during the intake process, Ms. Crook said. Nor do the claims handlers consistently input height and weight information into a claims system when the information is provided in medical reports.
Sedgwick Claims Management Services Inc. asks for an employee's height and weight during the claims intake process when employers request that service, said Teresa Bartlett, the TPA's medical director in Troy, Mich.
Height and weight are used to calculate a claimant's body mass index. When employers don't ask for the data during the intake process, nurse case managers obtain it later from the physician's medical notes, she said.
An employer's first indication that a claimant is obese often comes from the doctor's first report, which may not be available until several weeks into the claim process, said William Zachry, vp-risk management at Safeway Inc. in Pleasanton, Calif. Even then, height and weight may not be included, he said.
Yet that information is essential to assess whether a worker might benefit from services such as nutritional counseling, closer collaboration between a nurse case manager and their physician, or physical therapy, sources said.