Report: Reclassification of obesity could have 'significant' cost implications
An injured worker who gains weight due to inactivity or as a side effect of prescribed medications may be eligible for increased benefits, the report suggests.
The report assesses the potential impact on the workers' comp system of the American Medical Association's recent reclassification of obesity as a disease state. The California Workers' Compensation Institute analyzed claims data in that state from accident year 2005-10 and considered various possibilities.
"Historically, obesity in workers' compensation has largely been a comorbidity issue, and even on that level, it has gone largely unreported as it has not often been deemed a condition that must be addressed in order to treat most work-related injuries and illnesses, and medical providers typically only document medical diagnosis codes for injuries and conditions they intend to treat and wish to be reimbursed for," the report explains. "That may change, however, now that obesity has been reclassified as a disease if medical providers feel a greater responsibility to counsel obese patients about their weight -- especially if there is a greater likelihood that they will be reimbursed for doing so -- or if treatment for a compensable injury causes significant weight gain."
The AMA's House of Delegates approved a resolution in June reclassifying obesity as a disease state. While declarations by the AMA do not have legal standing, "the organization's positions often influence state and national lawmakers and regulators," the report states.
"Pressure on health care payers to cover obesity-related expenses is already building," according to the report. "Immediately following the AMA's vote to reclassify obesity as a disease, bipartisan bills were introduced in both the U.S. House and Senate to require Medicare to cover more obesity treatment costs, including prescription drugs and intensive behavioral weight-loss counseling."
The authors surmise workers' comp payers may see an increasing number of claims in which obesity is a comorbidity or where obesity is claimed as a compensable consequence of injury. While there are currently only a small percentage of California workers' comp claims with obesity as a comorbidity reported, the costs associated with them are much higher than other claims.
The overall total payments on claims with obesity comorbidity was 81 percent higher than claims without -- $116,437 compared to $64,231, the authors said. The medical benefit payments on claims with obesity comorbidity averaged $68,464 compared to $35,091, and indemnity payments averaged $47,970 for claims with obesity comorbidity -- nearly 65 percent more than the average for other claims.
Some 67.6 percent of claimants with obesity comorbidity received a permanent disability payment, more than 4.5 times the rate for claimants without obesity, the report says. Attorney involvement was "sharply higher among claims with the obesity comorbidity," the report says. More than 68 percent of the claims involved attorneys, nearly 4.5 times the attorney involvement of other claims.
Also driving costs for claims in which obesity was a factor was the cost of medications. The researchers found the use of narcotic painkillers, especially Schedule II opioids, and psychotropic drugs -- Prozac, Valium, and klonopin -- "was significantly higher among claims with obesity comorbidity than for those without."
In some cases, obesity may even become a primary workers' comp diagnosis, the authors said. Sedentary jobs such as long-haul trucking or office work requiring employees to remain seated for extended periods may lead to an obesity claim.
"In such scenarios the viability of the claim would likely hinge on proving that the work actually caused the obesity, which would be an issue ripe for dispute and which could lead to additional litigation," the report says. "In light of the increasing evidence of genetic pre-disposition for various medical conditions, defining causation and relative causation will be critical in claims involving obesity, and also may arise in other employment areas such as pre-employment screening."
The authors says it is also possible that workers' comp payers may subrogate against group health payers because of the requirement under the Patient Protection and Affordable Care Act that group health covers preexisting conditions. That may especially be true in claims where there is evidence the injured worker was obese prior to the work injury.
"Despite such uncertainties, it is clear is that the implementation of operational and financial changes stemming from the change in classification of obesity as a medical disease will create new challenges and incentives for control and treatment," the report says. "In a time of major reform within the California workers' compensation system, the impact of changes in the classification of obesity will be an area of continued study and scrutiny."
By Nancy Grover
Read more at the WorkersComp Forum homepage.
September 16, 2013
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