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Managing Comorbid Conditions

Posted by Eric Patten on May 17, 2018 at 9:53 AM

What is a Comorbid Condition?

In injured claimants, comorbid conditions can surface in the form of a pre-existing condition that is discovered upon the diagnosis of the injury. Some examples include depression, anxiety and diabetes. However, long term use of substances like tobacco or opioids may have a noticeable impact on the onset of what may be perceived as a comorbid condition (e.g. hypertension and cardiac issues), in turn making the condition difficult to assess from a claims perspective. 

Complications Created with Workers’ Compensation Claims

According to a report from the National Council on Compensation Insurance (NCCI) released in October 2012, the number of workers’ compensation claims involving a comorbid condition nearly tripled from 2000 to 2009. This report also showed that claims involving comorbidities had about twice the medical costs of otherwise comparable claims. 

In general, comorbidities impede an injured worker’s ability to heal, recover and return to work. As a result, claims involving comorbidities will include longer claims duration, higher medical and indemnity costs, more temporary disability (TTD) days, increased litigation rates and increased surgery rates, on average. 

Mitigating Comorbid Conditions

Long term disability, infections, increased cost in medical expense and the length of time employees spend out of work becomes more prevalent as a result of the proliferation of comorbid conditions. Claims specialists are beginning to set aside funds exclusively to help individuals improve their overall health in an effort to avoid longer periods of workers’ compensation spending due to comorbid conditions.

There has been a rise in employers implementing an emphasis on wellness to curtail the onset of comorbid conditions in employees and to enhance their employee-based health programs. Identifying such conditions early enables a holistic view of the patient’s health and a more comprehensive approach to care that can truly impact costs and outcomes in a positive manner. The most effective way to alleviate the burden caused by comorbid conditions is by establishing synergy between the claims adjuster, employer and employees.