January 02, 2011 BY Patricia Cunningham
Obesity: Supersizing Workers' Compensation Costs
We all know that being overweight is bad for an individual on many levels. Obesity can lead to poor self-esteem, depression, and social isolation. The Centers for Disease Control (“CDC”) reports that being overweight or obese increases the risk of acquiring numerous health conditions and diseases such as hypertension, Type II diabetes, osteoarthritis, high cholesterol, and coronary artery disease -- to name just a few. In addition, a recent study in the Journal of Occupational and Environmental Medicine reports that in a survey of overweight and obese people, more than 30% of those who responded indicated that they suffered from two or more of the aforementioned diseases (i.e., “co-morbidities). The presence of co-morbidities among overweight or obese individuals is also associated with more days of hospitalization, more visits to the emergency room and medical providers. While obesity obviously presents serious health concerns for those who are overweight, it also appears to have serious implications with regard to the frequency and cost of workers’ compensation claims filed today.
According to the Nation Council on Compensation Insurance (“NCCI”), claims involving obese injured workers have “markedly higher” indemnity and medical costs. The results of a 2007 study by Duke University Medical Center (the “Duke Study”) bears this out. The researchers in the Duke Study examined the relationship between mass index (“BMI”) and the rate of workers’ compensation claims. Because BMI takes into account a person’s height and weight, it is considered the most accurate measure of obesity. For Americans, a BMI of 18.5 to 24.9 is considered normal. 25-29.9 is considered overweight; and 30 and above is considered obese.
To put this in perspective, a gallon of milk weighs 8.35 pounds. Every 10 pounds of weight increases the force on your knees by 30 to 60 pounds with each step. Now, imagine an average size man (5’10” tall; 150 pounds) carrying 7 gallons of milk tied around his waist every moment of every day. This 60-pound “belt” is the weight difference between an average male with a mass index (“BMI”) of 21.5, the middle limit for normal weight, and one with a BMI of 30, the lowest level in the obesity range. Unfortunately, this is situation is not as uncommon as you might think. Studies show that almost 1/3 of the adult population in the United States carries approximately 60 or more pounds of excess weight. Many of these obese individuals are employed on a full-time or part-time basis making them eligible to receive workers’ compensation benefits if they are injured on-the-job.
Interestingly, studies show that morbidly obese workers – anyone with a BMI of 40 or above - file twice as many workers’ compensation claims than their non-obese co-workers. In addition, a study by Johns Hopkins Bloomberg School of Public Health found that the probability of an obese worker being injured on the job is significantly higher than those workers with a normal BMI. Also, morbidly obese workers had 13 times the number of lost workdays when compared with those with BMIs in the normal range. But, perhaps the most striking finding is that the medical costs associated with morbidly obese workers were 7 times higher than those of non-obese workers, and the indemnity costs of the obese injured workers were 11 times higher! Moreover, the costs of such claims continues to increase the longer such claims remain open.
There are numerous factors that contribute to these increased costs. For example medication dosage is based on an individual’s weight. It takes 295 units of the antibiotic Cubicin to treat a 130-pound person at a cost of approximately $590.00 per treatment. However, it takes 800 units, at a cost of $1,600.00 per treatment, to treat a 350-pound claimant with the same drug. Also, obese claimants requiring surgery are at a higher risk for forming blood clots and may not have the physical capacity to participate fully in a work-hardening program designed to move them back to work, resulting in increased indemnity costs. Then, there are the potential costs associated with an authorized treating physician’s prescription for a weight-reduction program for an obese claimant with a back or knee injury before agreeing to perform surgery.
Although it is not presently the law in Georgia, there is a growing trend by some states to insurers to pay for an obese claimant’s bariatric surgery (i.e., gastric by-pass surgery) as part of the claimant’s treatment for his or her on-the-job injury. This has already occurred in other jurisdictions such as Oregon, New York, and Indiana. For example, in 2009, the Court of Appeals of Indiana, held in Boston’s Gourmet Pizza v. Adam Childers, that the employer had to pay the injured worker temporary total disability benefits while he prepares for, and recovers from, weight-loss surgery. Childers, was a 25-year-old, 6-foot tall cook who weighed approximately 340 pounds in 2007. While working, he was struck in the back by a refrigerator door and suffered a back injury. On the advice of his doctor, Childers underwent gastric-bypass surgery and filed a claim for reimbursement for the cost of the surgery under his state’s workers’ compensation program. The doctor was of the opinion that Childers would continue to suffer back pain from the refrigerator door incident if he did not lose weight.
The Indiana Workers’ Compensation Board (“Board”) found that Childers was entitled to receive “secondary medical treatment, including surgery, for weight reduction as a precursor to his primary entitlement to back surgery to directly repair the result of his work-related accident.” The board further determined that Childers should receive temporary total disability benefits “while preparing for, undergoing and recovering from both his secondary and primary surgeries to treat his work-related injury.” Not surprisingly, Boston’s appealed, but the state appeals court upheld the Board’s decision.
Presently, in Georgia, the greatest cost drivers are co-morbidities, such as diabetes, because they interfere with the healing process. For example, a minor leg fracture in an obese claimant with diabetes has the potential to become a complex and expensive claim. Such claims often take much longer to resolve, which requires the insurer to set higher reserves to take into account the longer recovery period and the increased costs associated with obese claimants.
It is fairly common to associate obesity with generalized health problems such as low back, knee, hip and wrist pain. The same holds true for workers’ compensation injuries. The Duke Study looked at whether certain kinds of on-the-job injuries might be related to a person being overweight. Obese workers appear to be more prone to injuring their lower extremity, wrist, hand, and back. The most common causes of such injuries were falls, slips, or lifting. In addition, there are several occupational groups at greater risk for an on-the-job injury, including: laundry staff, housekeepers, nurses, nurses’ aides, and facilities maintenance employees. Newly hired employees are also at greater risk of an on-the-job injury due to a lack of training and/or experience.
In most cases, employers pay a great deal of attention to providing and maintaining a safe workplace for their employees. However, given the empirical data that indicates there is a strong link between obesity and the increased costs associated with the average workers’ compensation claim, ensuring that employees maintain a healthy weight is not only in the best interest of the individual employee, but it is in the best interest of the employer’s bottom-line as well. A high priority should be given to work-based and/or employer-sponsored programs designed to encourage employees to eat healthier and exercise more frequently. For example, it is becoming increasingly common for employers to provide healthy cafeteria food, healthier snacks in vending machines, and on-site fitness facilities or subsidized gym memberships for their employees. Such programs not only improve the overall health of employees, but also financially benefit the employer as well. In addition, employers should focus on preventing injuries to those areas of the for which obese workers are at a higher risk, (i.e., back, wrist, hand, and lower extremities).
One suggestion for increasing workplace morale while encouraging employees to get into shape might be for the employer to hold a company-wide “Biggest Loser” contest for a 12-week period of time (preferablybefore the holidays!). While allowing individual employees to develop their own weight-loss plans, success would be measured by a team’s total weight loss. Small weekly fitness-oriented prizes could be offered as incentives, and a “grand prize” could be awarded to the team that looses the most weight at the end of the 12-week competition.
By targeting obesity in the workplace, employer’s can increase the overall health of its workforce, reduce absenteeism, and decrease the frequency and cost of workers’ compensation claims associated with obese employees.
The Journal is a publication for the clients of Drew Eckl & Farnham, LLP. It is written in a general format and is not intended to be legal advice to any specific circumstance. Legal Opinions may vary when based upon subtle factual differences. All rights reserved.
H. Michael Bagley