Published by the Public Risk Management Association
www.primacentral.org
January 2014
Obesity Weighs on Workers’
Compensation Claims
By Kevin Glennon
If actions aren’t taken to halt weight gain in the U.S., 42 percent of Americans could be obese by
2030, according to Duke University’s 2012 study.1 This means the total number of obese individuals
could be as high as 32 million and could cost the U.S. health care system as much as $550 billion in
obesity-related health issues.
Those obesity-related health issues are also having a profound effect on workers’ compensation
claims. For the last few years, the National Council on Compensation Insurance (NCCI) has studied
the impact of obesity in workers’ compensation and found that work-related injuries are far more
costly if the injured worker is obese.
In this article, we examine the scope of the obesity epidemic, discuss multiple ways it affects
workers’ compensation programs, explore strategies to better manage claims involving weight
issues and outline risk management strategies, such as employee wellness and weight loss
programs, which could help to rein in the growing obesity trend.
January 2014 | Public Risk
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Defining the Weight Problem
In order to effectively manage work-related injuries that
involve obese workers, public risk management professionals
must understand the complex multi-faceted ways that
obesity affects costs, duration and outcomes of claims. We
identified eight key factors.
Eight Ways Obesity Weighs on Workers’
Comp Claims
Higher Frequency of Injury. In 2007, Duke
University performed a landmark study on obesity’s
impact on workers’ compensation, “Obesity Increases
Workers’ Compensation Costs.”2 This study found that
on average obese workers filed twice as many workers’
compensation claims as non-obese employees.
Common Types of Injuries. Generally, obese
workers are more prone to injure their lower extremities,
wrist or hand and back. Common causes of these injuries
include falls, slips and lifting.
Higher Rates of Comorbidities. Being overweight
or obese increases the risk of comorbid conditions,
such as high blood pressure, heart disease, diabetes,
osteoarthritis, stroke and many orthopedic problems.
Comorbid conditions complicate workers’ compensation
cases. For example, if an obese injured worker has
diabetes and is not careful with daily nutritional intake,
then that individual may experience increased blood
sugar levels, poor circulation and even tissue death (also
called necrosis), which all interfere with the healing
process and makes it difficult to achieve recovery.
Increased Severity. Obese workers often experience
more severe injuries than individuals with normal body
mass index (BMI). With every extra 10 pounds of body
weight, there is an increased force upon an individual’s
knee joint that is equivalent to 30 to 60 pounds with each
step. This force increases on the body part (whether it be
an ankle, knee, or wrist) that bears the brunt of impact
from a fall or similar workplace accident. In addition,
obese individuals often already have orthopedic problems
and osteoarthritis, which affect the hands, hips, knees and
back. These factors can contribute to increased severity.
Increased Medical Costs. The 2007 Duke Study
found that claims filed by obese employees cost seven
times more than similar claims from non-obese workers.
Higher Indemnity Costs. Weight-challenged
claimants miss 13 times more days from work than claimants
with normal BMI and comparable injuries. And according to
NCCI, the duration of workers’ comp indemnity benefits paid
to obese workers is at least five times greater than those paid to
claimants who are not obese but had comparable claims.
Greater Risk of Disability. The 2010 NCCI study
also found that obese workers were more likely to become
permanently disabled.
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Public Risk | January 2014
Other Complications. The longer obese workers
are away from work the more they may lose physical
conditioning and actually gain more weight. Obese
workers may have increased risk of depression and
other mental health issues, which can make them more
susceptible to a dependence on pain mediations. Claims
data has shown some correlation between obesity, chronic
pain and use of narcotics.
Obese claimants that have undergone surgery are more at
risk for blood clots. In some states, payers have been forced
to cover the costs of weight-loss programs and even bariatric
surgery, as physicians claimed treatment could not progress
unless claimants lost weight.
Managing the Injuries of Obese
Workers
When dealing with workers’ compensation claims,
examiners should immediately observe the claimant’s weight
and height in order to determine the individual’s BMI.
Often, 250 pounds is a weight that should set off a red flag.
If the claimant is found to be overweight (with a BMI
between 25 and 29.9) or obese (with a BMI at 30 or
above), the examiner then knows that the claimant will
likely require special treatment, recovery considerations,
equipment, home care and return-to-work planning.
They should quickly ascertain if comorbid conditions exist,
which can affect the healing process and cause the claim to
become more complex, chronic and expensive. Since obese
claimants with comorbidities generally require a longer
recovery and increased medical costs, examiners should also
take this into account when setting reserves.
When dealing with particularly complicated obesity-related
issues, claims examiners may choose to work with a complex
care specialist, who can help determine if and what types
of bariatric equipment may be needed, including walkers,
crutches, wheelchairs and lifts.
A complex care specialist will also help to identify other critical
issues. For example, depending on weight, increased antibiotic
dosage may be required. A 130-pound claimant would require
295 units of the antibiotic Cubicin, which would cost $590
per dosage, while a 350-pound claimant would require
approximately 800 units, costing $1,600 per treatment.
A complex care specialist will have licensed clinical staff to
effectively oversee obesity-related cases and comorbidities
in order to control costs and shorten the claim’s duration.
These specialists also help to coordinate special treatment and
therapy needs to help get injured workers back on the job.
www.primacentral .org
Obesity Weighs on Workers’ Compensation Claims
Encouraging Wellness in the
Workplace
For future risk management, programs should analyze
past claims to identify the types of injuries commonly
experienced by their weight-challenged employees and come
up with a game plan to address these specific exposures.
Frequency and severity of obesity-related claims is taking
a tremendous toll on the workers’ compensation system.
Today, employers may be committed to creating a safe
workplace, but with the implications related to obesity,
wellness and weight-control programs are also being
considered and growing in popularity.
These programs offer significant advantages. In addition to
helping to reduce workers’ compensation costs, they can
improve the overall health and wellness of the workforce,
contribute to decreased healthcare spending, reduce absenteeism, as well as improve morale and productivity.
Weight-loss programs, such as walk-at-lunch, bike-to-work,
or the “Biggest Loser” type programs, have been shown
to be effective, when leveraging the right incentive and
support mechanisms. For example, employees who signed
up for a six-month program at two Boston-area workplaces
experienced an average weight loss of 17 pounds.
Workplace programs have the potential to become a critical
component to our nation’s efforts to control and reduce obesity.
A vast majority of Americans go to worksites each day, where
they spend a significant amount of time and engage in social
groups that can offer weight-control encouragement and
support. As part of these programs, employers often provide
education on nutrition and modify cafeteria menus and
vending machine choices to include more healthy options.
In the end, more important than the money saved is the
impact that employers can make on their employees’ quality
of life and future well being.
Kevin Glennon is vice president of Home Health and Complex
Care Services at One Call Care Management, with over 30
years of experience in healthcare, encompassing clinical and
claims management for workers’ compensation, auto and
general liability.
Footnotes
1Eric Finkelstein, PhD, MHA, Olga Khavjou, MA, Hope
Thompson, BA, Justin Trogdon, PhD, Liping Pan, MD,
MPH, Bettylou Sherry, PhD, RD, and William Dietz, MD,
PhD, “Obesity and Severe Obesity Forecasts through
2030,” American Journal of Preventive Medicine, June 2012.
2 Duke University Medical Center, “Obesity Increases
Workers’ Compensation Costs,” April 23, 2007.
Published in Public Risk, January 2014. Copyright 2014. All rights reserved.
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