Obesity and Workers' Comp
Tuesday, September 3, 2013 | 0
The so-called "obesity epidemic" in the United States may have major implications for workers' comp.
That's the conclusion of a remarkable August 2013 white-paper study by Alex Swedlow and Bob Young of the California Workers' Compensation Institute, "Obesity as a Medical Disease: Potential Implications for Workers' Compensation."
A June 2013 resolution on obesity was approved by a Chicago meeting of the House of Delegates of the American Medical Association. The AMA now classifies obesity as a "disease state." The resolution reads as follows:
"RESOLVED, That our American Medical Association recognize obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention."
This was controversial within the AMA. A National Public Radio report by Scott Hensley noted that "within the AMA there was some uneasiness about the disease label. A report on the proposed resolution from the group's Council on Science and Public Health didn't support it. The analysis noted the lack of a clear definition of what constitutes a disease and whether obesity would fit, in any case. The report also raised practical concerns.
Hensley quoted the AMA committee report as follows:
"Similarly, a sensitive and clinically practical diagnostic indicator of obesity remains elusive. Obesity, measured by [body mass index], is clearly associated with a number of adverse health outcomes, with greater consistency across populations at the highest BMI levels. However, given the existing limitations of BMI to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a 'condition' or 'disorder,' will result in improved health outcomes. The disease label is likely to improve health outcomes for some individuals, but may worsen outcomes for others."
But in the end, those within the AMA who proposed the disease model were victorious over those who saw it as more of a risk factor.
So if obesity is a disease, the implications for workers' comp may be profound.
Here is what the CWCI study concludes:
"Historically, obesity in workers’ compensation has largely been a co-morbidity 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. 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 result could be an increasing number of claims that include obesity as a co-morbidity, as well as an increase in cases in which obesity is claimed as a compensable consequence of injury in the same way that sleep disorders, sexual dysfunction and psychological disorders became commonplace prior to the passage of SB 863."
The scenario is a familiar one to many workers' comp practitioners. A worker who has a back injury or a knee injury is less mobile and gains weight.
Maybe they are snacking more. Maybe they are depressed and using food to cope. Other health issues emerge.
With the AMA-imprimatur, there's likely to be more focus in workers' comp on the causation of obesity in injured workers and the interrelationship between the injury, weight and other conditions.
The CWCI report concedes this, noting that:
"Within workers’ compensation, the issue of obesity is not new, but until now, obesity has almost exclusively been treated as a co-morbidity – a condition that occurs at the same time, but usually independent of the work-related compensable injury or illness. For example, obesity as a comorbidity within a workers’ compensation claim can complicate the treatment of a compensable back or joint injury. Now that obesity has been designated as a medical disease, however, it may become more common as a compensable consequence of injury in the same way that prior to the passage of SB 863 in 2012, sleep disorders, sexual dysfunction, and psychological disorders became common “add-ons. This could be especially true in cases where the injured worker remains off work and is inactive for extended periods, or where they are given a medication such as prednisone, where the side effects can include rapid weight gain."
Might we be on the verge of seeing claims where it is alleged that obesity is not merely a secondary result of an injury, but rather the direct result of the type of activity the worker does on the job?
This possibility is noted by the CWCI study, which says that:
"Beyond the potential for the increased incidence of obesity as a compensable consequence, there also is some concern that obesity may become a primary workers’ compensation diagnosis, especially in sedentary jobs such as long-haul trucking or many types of office work, where the job demands that the worker remain seated for extended periods, making them prone to weight gain. 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. 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 idea that claims costs are higher in cases of obese workers is not new. A 2009 study by the National Council on Compensation Insurance claimed that costs of claims that are open for five years are more than five times higher than for non-obese workers.
And an earlier Duke University study had noted that obese workers filed more claims, that the costs of those claims were as much as seven times higher and that significantly more lost time was involved than for non-obese workers.
Using data from the Workers' Compensation Information System database, the CWCI documents significant links between obesity and permanent disability payments. There was also a significant correlation between obesity and claims of various metabolic, circulatory, mental health and substance abuse claims. Also, opioid and psychotropic medication use was significantly higher in claims where there was obesity.
The CWCI report notes that, "Obesity is much more prevalent among California injured workers than has been indicated by the 0.9% of all claims that have an ICD-9 code for obesity in the medical bill submissions, suggesting that the number of workers' compensation issues in which obesity will need to be addressed may increase dramatically."
Related stats that are somewhat shocking are in the CWCI reports that on claims from 2005 to 2010 included an obesity diagnosis code:
- Average medical payments were 95% higher than those without.
- Indemnity payments were nearly 65% higher.
- The average number of work days was 80% higher.
Bottom line?
..."any increase in the volume of claims involving the treatment of obesity could have a significant impact on workers' compensation losses."
Obviously this is an issue that the insurance industry is concerned about.
A mitigating factor is that California tends to have less of an obesity problem than many other states. But there is much to be done.
Perhaps this report might encourage some wise California employers to remove the soda and chips vending machines, placing more emphasis on company health education and wellness programs.
Stay tuned.
The CWCI study can be found here.
Julius Young is an applicants' attorney with the Boxer & Gerson law firm in Oakland. This column was reprinted with his permission from his Workers' Comp Zone blog.
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