Ignoring coexisting conditions can have nightmarish ramifications, expert warns

Getting a handle on skyrocketing costs in the workers' comp system could be as simple as setting up a weight loss program for your employees. Excess weight is one of the factors that can turn a seemingly uncomplicated claim into a significant outlier case, according to a workers' comp insurance executive.

Overweight/obesity, along with smoking, diabetes, and hypertension are among the comorbid conditions that are creeping into the workers' comp system and turning manageable claims into the stuff of nightmares. They are, as one expert puts it, that small subset of claims that should not have gone bad -- but did.

"It's astonishing to see a very large number started as soft tissue injuries," said Maureen McCarthy, senior vice president and manager of workers' compensation claims for Liberty Mutual. "Somewhere along the line they were derailed."

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The types of cases McCarthy is alluding to are not catastrophic losses. They are minor injuries that suddenly become complex because the injured worker has physical problems of which he may not even be aware.

"We have a lot of customers frustrated by the fact that they are doing everything they can to keep their employees healthy through wellness programs, health insurance, etc.," McCarthy said, "but they see losses where someone has a simple benign type injury and, lo and behold, they have significant comorbid conditions and the injured employee doesn't even know."

McCarthy recently spoke on a panel addressing comorbidities at the National Workers' Compensation and Disability Conference® & Expo, produced by LRP Publications. She said the aging workforce may result in an increased number of such cases as many older workers have more risk factors.

McCarthy does not suggest employers refrain from providing wellness programs or health assessments to their workers. In fact, she says it's important to identify comorbid conditions before a worker becomes injured.

"Sometimes they need surgery which includes a surgical workup and that's where they are beginning to understand, 'hey, you have borderline diabetes or hypertension," she said. "That's a big part of the issue -- getting an understanding of those things early before a person actually has the treatment that could end up derailing them because they are not healthy enough to undergo the treatment, especially surgery."

Successfully treating a claimant who has comorbid conditions may require patience, McCarthy explains. She says someone who takes more time to recovery is not necessarily a malingerer.

"Sometimes we, collectively, are under so much pressure to speed the claim along, we feel we've got to do something; get an MRI, get a surgery, get him back to work," she said. "Sometimes those are good strategies, but sometimes it can derail the claim."

In those situations, Liberty Mutual tries to work with brokers to explain to employers that slowing down the process can help in the end. "It gives the injured worker time to get the diabetes under control, go through a weight loss program before significant surgery, or quit smoking."

Read more at the WorkersComp Forum homepage.

December 8, 2011

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