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Workers’ Comp Claims Involving Obesity Could Increase

Published on Aug 8, 2013 at 2:55 pm in Workers Compensation.

Workers’ comp claims involving obesity could increase because of a recent ruling by the American Medical Association (AMA). The AMA declared in June that obesity is a disease.

The California Workers’ Compensation Institute (CWCI) has already published a report indicating that the number of work injury claims involving obesity could increase sharply as a result of the ruling.

Obesity, according to CWCI, may become more common “as a compensable consequence of injury, just as sleep disorders, sexual dysfunction and psychological disorders became common workers’ compensation ‘add-ons’ prior to passage of workers’ comp reforms in 2012.”

“For example,” CWCI said, “this could be the case in claims where the employee remains off work and gains weight after being inactive for extended periods, or where they are treated with drugs that cause weight gain. If work causation can be proven, workers in sedentary jobs such as long-haul trucking might even file claims in which obesity is the primary diagnosis.”

In other words, the claim that your job made you fat could become compensable under workers’ compensation.

Obesity has historically been a co-morbidity – a condition that occurs at the same time, but is independent of an injury or illness in workers’ compensation claims. In the past, a medical provider might include an obesity co-morbidity code on their medical bill if they felt the condition needed to be addressed so that the work injury could be treated and the patient could recover and return to work. For example, if an obese, injured worker needed to lose weight before they could have back surgery. However, that might change if there is a greater likelihood that they will be paid for doing so, CWCI said.

Claims involving obesity are more expensive. CWCI found that paid losses on claims with the obesity co-morbidity averaged $116,437, or 81.3% more than those without. CWCI also found that the claims averaged nearly 35 weeks of lost time, or 80% more than the 19 week average for claims without the obesity co-morbidity.

In coming to its conclusions, CWCI studied 1.2 million open and closed California claims between 2005-2010 to get a feel for what the reclassification of obesity might mean for future claims. CWCI discovered that the average medical payments on those claims that now would factor in obesity “were nearly twice as much as those without ($68,468 vs. $35,091), average indemnity payments were 65 percent higher ($47,970 vs. $29,140) and the average number of lost work days was 80 percent higher (242.6 vs. 134.7).”

The workers’ compensation group at Belsky, Weinberg & Horowitz reminds that the AMA’s declaration has no legal effect but is influential. The real impact will come if the AMA guidelines are updated. We will be keeping a close eye on this issue to see if its going to be accepted in Maryland.

Baltimore, Maryland-based Belsky, Weinberg & Horowitz has represented consumers in workers’ compensation cases for many years. Call our attorneys at 410-234-0100 or email us for a free consultation.

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