Comorbidities in Workers Compensation

Posted Date: November 14, 2012
    

Industry InformationResearch

Introduction

While the average medical cost for a workers compensation claim is approximately $6,000, the medical cost of an individual claim can be a few hundred dollars or millions of dollars. In 2010, an NCCI study found that claims with an obesity comorbidity diagnosis incurred significantly higher medical costs than comparable claims without such a comorbidity diagnosis. Relative to that study, this study expands the number of comorbidities examined and provides additional information on both the types of claimants receiving comorbidity diagnoses and the types of providers submitting comorbidity diagnoses.

Key Findings

  • The share of workers compensation claims with a comorbidity diagnosis nearly tripled from Accident Year 2000 to Accident Year 2009, growing from a share of 2.4% to 6.6%
  • Claims with a comorbidity diagnosis have about twice the medical costs of otherwise comparable claims
  • Comorbidity diagnoses for hypertension are the most prevalent of those investigated
  • The initial comorbidity diagnosis tends to occur early in the life of a claim
  • Hospital and physician visits account for a majority of visits resulting in a recorded comorbidity diagnosis
  • Only a small portion of visits result in the recording of a comorbidity diagnosis. A healthcare professional must record the comorbidity diagnosis in the course the workers compensation claim. The absence of such a diagnosis does not mean that the claimant does not suffer from the comorbidity nor that the healthcare professional did not make such a diagnosis. Its absence only implies that a healthcare professional did not record such a diagnosis as part of the workers compensation claim.