BI’s Article search uses Boolean search capabilities. If you are not familiar with these principles, here are some quick tips.

To search specifically for more than one word, put the search term in quotation marks. For example, “workers compensation”. This will limit your search to that combination of words.

To search for a combination of terms, use quotations and the & symbol. For example, “hurricane” & “loss”.

Login Register Subscribe

Weighing the benefits of bariatric surgery

Weighing the benefits of bariatric surgery

The bottom line versus the waistline in workers compensation is becoming an all-too-familiar battle for experts who say the industry may be more willing to pay for bariatric surgery in order to remedy escalating comp claim costs associated with obesity.

“There are some situations where you might want to (pay for weight-loss surgery) as an employer,” said Kim Brown, Kansas City, Missouri-based vice president and senior claims consultant with Lockton Cos. L.L.C. “If a claim is to a point where nothing can happen until that person loses weight, if you are looking at a lifetime claim, you might say, ‘Let’s pony up for that one.’”

According to the U.S. Centers for Disease Control and Prevention, more than 36% of adults in the United States are considered obese, and the agency predicts that 42% of Americans adults will be obese by 2030. Medical experts have long associated health issues with obesity, including diabetes, heart disease, hypertension and more.

“This definitely has an impact on workers comp,” said Dr. Teresa Bartlett, Troy, Michigan-based vice president of medical quality at Sedgwick Claims Management Services Inc.

Dr. Bartlett cited a 2012 Duke University study that found obese workers filed twice the number of workers comp claims and lost 13 times more days of work when injured compared with workers who are not obese.

Other experts point to researchers at Johns Hopkins University in 2007 who studied data on 7,690 injured workers in aluminum manufacturing and found that 85% of them were overweight or obese.

An obesity diagnosis could prolong a workers comp claim by 55% compared with claims for injured workers who are not overweight, according to a study released in December by Newport Beach, California-based Harbor Health Systems, a division of One Call Care Management that manages workers comp medical provider networks. The analysis also found that surgery rates increased 140% when an injured worker was obese.

Harbor Health President Linda Lane said obesity “has to be addressed” if workers comp payers want to avoid lengthy and costly comp claims.

“If you are an employer looking at an individual and you are evaluating a course of care, this needs to be squarely in your line of sight,” she said.

The Boca Raton, Florida-based National Council on Compensation Insurance Inc. in 2012 found that claims with an obesity comorbidity have 81% higher lost-time costs compared with claims involving nonobese injured workers. That was the highest cost difference among all comorbidities studied by NCCI, including diabetes and hypertension.

Barry Lipton, practice leader and senior actuary with NCCI, said obesity is a cost driver in workers comp because some workers won’t heal from their injuries without losing weight.

Experts say an increasing number of doctors are recommending weight-loss surgery for obese injured workers, while judges are ruling that bariatric is compensable under comp claims.

Multiple sources put the price tag for bariatric surgery at $23,000 with varying time for recovery and significant weight loss achieved within a year — barring no major complications.

Historically, employers and workers comp insurers have fought recommendations to pay for an injured worker’s bariatric surgery, Mr. Lipton said.

“The bariatric surgery is not a direct workers comp issue … It usually becomes an issue because (a different) surgery is needed and can’t be done because someone is overweight,” he said.

Studying her own casework through Sedgwick, Dr. Bartlett found that workers comp claims managers approved payment for 19 bariatric surgeries in the past three years. However, she said, “For the most part it wasn’t willingly … In the cases that we’ve paid for, there has been litigation and there’s no way out.”

Christina Bergman, Prescott, Wisconsinbased managing director for Aon Risk Solutions, said oftentimes an injured obese worker will gain more weight while at home recovering from an injury that won’t heal without weight loss.

The decision of whether to pay for bariatric surgery is part of a cost-benefit analysis that should be performed for comp claims, Ms. Bergman said.

“If they don’t have the bariatric surgery, will it get worse?” she said.

Dennis Tierney, New York-based director of workers compensation claims for Marsh L.L.C., said he thinks costs and savings “are going to drive the behavior” in relation to paying for bariatric surgery. But he said many employers and workers comp insurers are “not there yet” when it comes to willingly paying for the procedure.

“I think a lot of depends on the employer and the carrier, (and) it’s going to depend on how aggressively they want to pursue (closing the claim),” he said.