Aging workers pose comp claims challenges

The aging U.S. workforce is a rising concern for employers and workers compensation insurers as older worker injury claims are more likely to contain comorbidities.

Older workers usually have greater expertise than younger co-workers and are injured less frequently but they often have more preexisting health issues than younger workers, making comp claims more complex.

As life expectancy increases and people retire later, the average age of many workforces will likely continue to rise, making effective return-to-work programs and other strategies more important, experts say.

“We know that when you’re older, you tend to have more chances of having a comorbidity, you tend to have more chances of having another medical condition,” said Dennis Tierney, Norwalk, Connecticut-based national director of workers compensation claims for Marsh LLC.

Gallagher Bassett Services Inc. says its claim distribution by employee age closely mirrors the overall U.S. labor force and it projects that by 2032, workers aged 55 and over will likely generate around a quarter of all claims.

Figures provided by the third-party administrator show that workers comp claimants aged 35 or older account for 61% of claim volume and 80% of all claim dollars.

And the age of claimants is tied to increased claim costs, more lost workdays and lower claim closure rates, according to Gallagher Bassett.

The U.S. Census Bureau projects that by 2030, one out of five U.S. residents will be older than 65, likely translating to more, and longer, participation in the labor force. And the Bureau of Labor Statistics has said it expects 96.5% growth in the labor market of workers 75 and older between 2020 and 2030.

When older workers are injured and undergo tests such as imaging scans, underlying degenerative conditions can be uncovered, which can further complicate treatment and lead to questions over whether any of the discovered issues are work related, according to experts.

Other age-related developments may also affect claims, said Judiann Romeo, Youngstown, Ohio-based assistant vice president of clinical operations for Sedgwick Claims Management Services Inc.

“We have older workers with workers comp injuries that may have hearing difficulty, vision or ambulation issues, comorbidities such as diabetes or even lung issues,” she said.

Comorbidities can have a direct effect on a work injury or hinder the healing process, Ms. Romeo said. Prescription medications used by injured workers for unrelated conditions can also hamper recovery, she said.

In addition, older workers are more prone to injury from accidents such as falls, and bone fractures can take longer to heal, said Dr. Mary Capelli-Schellpfeffer, vice president and national medical director for Boston-based Liberty Mutual, Global Risk Solutions, Workers Compensation Claims.

Recovery is also likely to be affected by underlying medical conditions that aren’t tied to employment, such as high blood pressure, diabetes and higher body mass index, she said.

Older workers may also require more physical therapy sessions than younger workers, and they might have to be out on total temporary disability for longer, she said.

“The recovery period is going to be longer when it’s an older person,” said John Geaney, co-chair of the workers compensation practice at Mt. Laurel, New Jersey-based law firm Capehart Scatchard PA. “It’s going to be more difficult to perhaps get them back to baseline.”

Meanwhile, aging workers on the job site can pose a greater risk for employers, and it’s not unusual for some of these types of workers comp cases to end up in litigation, Mr. Geaney said (see related story).

Managing claims

Some insurers say managing aging worker claims should involve a team approach, ensuring that injured workers maintain a relationship with a primary care physician and that they stay on top of their overall health to help facilitate faster healing if they do become injured on the job.

These types of claims might also require nurses and other specialists, as aging workers might need more, and enhanced, medical care, Dr. Capelli-Schellpfeffer said.

Managing claims for older workers often involves a whole-body approach, as opposed to focusing attention exclusively on the specific work injury, said Jennifer Cogbill, Frisco, Texas-based senior vice president of GB Care, a division of Gallagher Bassett.

“Properly supporting injured workers holistically (in) the aging workforce is certainly an area of focus,” she said.

In managing these types of claims there is also an element of familiarity for older workers, as they may have had prior experience with workers compensation and understand the process better, said Matt Zender, Las Vegas-based senior vice president of workers compensation strategy at Amtrust Financial Services Inc.

Older workers know how to “work with doctors in a way that gets them back healthy,” Mr. Zender said.

This article was first published in Business Insurance.

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