Exclusively from Foa & Son
Last June the American Medical Association (AMA) House of Delegates approved a resolution reclassifying obesity as “a disease state”. “Obesity” is generally measured by Body Mass Index, calculated from an individual’s height and weight. BMI categories include Underweight, defined as a BMI less than 18.5; Normal weight, a BMI of 18.5 to 24.9; Overweight, a BMI of 25 to 29.9; and Obese, a BMI of 30 or greater. In practical terms, by this measure a man six feet in height would be normal weight at between 136 and 184 pounds, overweight at up to 229 pounds and obese over that. An additional category would include extremely obese, at 295 pounds or more.
To understand the effect of this resolution, consider that the AMA has effectively declared that the one third of all Americans who fall into the obese category, based on BMI, suffer from a medical condition that requires treatment.
What does this mean to you? In workers’ compensation obesity has historically been viewed as a co-morbidity factor, a condition that occurs at the same time, but usually independent of, any work related injury or illness. Now that obesity has been reclassified as a disease if a claimant is obese or if treatment for a compensable work injury causes significant weight gain doctors may feel a greater responsibility to provide treatment for obese patients for their weight…especially if there is now a greater likelihood that they will be paid for doing so.
Translated into dollars and cents, recent research by the California Workers’ Compensation Institute (CWCI) looked at claims data from a sample of 1.2 million claims from accident years 2005 to 2010 to establish a baseline to measure the potential impact of this new determination. In these years medical providers might have included an obesity co-morbidity code on their medical bill if they determined the condition needed to be addressed so that the work injury could be treated to allow the patient to recover and return to work; one example of that would be if an obese injured worker needed to lose weight before undergoing back surgery. The CWCI research determined that paid losses on claims with obesity identified as a co-morbidity factor averaged $116,437, or 81.3 percent more than those without; and that these claims averaged nearly 35 weeks of lost time, or 80 percent more than the 19 week average for claims without obesity co-morbidity. For financial folks who are arithmetically inclined, if one up to third of your claimants cost 81% more, that would indicate a potential increase in total WC claim costs around 27%. That’s likely a high estimate since obesity was already a factor in some claims, but there seems to be little doubt that the AMA decision has a significant potential to translate into higher WC claim costs, and thus higher premiums.