Hypertension, Other Conditions Increase Workers’ Comp Medical Costs

Medical costs in workers’ compensation cases with a comorbidity diagnosis are about double that of otherwise comparable claims, according to a new report from the National Council on Compensation Insurance. Comorbidity is the presence of a disease or medical condition in addition to a worked-related injury or illness. Among 24 conditions studied (including pregnancy), hypertension is the most prevalent, followed by drug abuse, diabetes and chronic pulmonary disease. Other key findings:

  • The rate of workers’ compensation claims with a comorbidity diagnosis nearly tripled between 2000 and 2009.
  • Most claims are medical-only, but about half with a comorbidity diagnosis involve lost time, and an obesity diagnosis is at least four times as likely to involve lost time.
  • Only a small percentage of workers’ compensation treatment encounters result in a comorbidity diagnosis.
  • Other than obesity, more than half of claimants who receive a comorbidity diagnosis within five years of their date of injury are initially diagnosed within the first month.

The findings are based on claims for which a medical provider billed a service with an ICD-9 code corresponding to a comorbid condition. Comparisons to national data collected by the Centers for Disease Control and Prevention suggest comorbidity in most claimants is not diagnosed through the workers’ compensation system, according to the NCCI report.