Comorbid health conditions are contributing to longer disability periods and substantially higher medical costs in workers compensation claims, yet the conditions often remain underreported in part due to communication gaps among patients, medical providers, and insurers and employers, according to experts.
“We’re not asking, and they’re not telling us,” said Mark Williams, Scarborough, Maine-based medical director at The Hartford, during a session at the Workers’ Compensation Institute’s Workers’ Compensation Educational Conference on Monday.
Comorbidities — including hypertension, diabetes, cardiovascular disease, obesity, mental health conditions and substance use — ranked as the top barrier to recovery and the top driver of claims complexity in a recent workers compensation industry survey conducted in part by Healthesystems, said Silvia Sacalis, the company’s Tampa-based vice president of clinical services.
The issue is becoming more significant, as research shows the effect of underlying conditions on workers comp outcomes, Mr. Williams said.
National Council on Compensation Insurance research presented in 2026 found medical payments were about twice as high for claims involving degenerative conditions, three times as high with hypertension, four times as high with diabetes and at least five times as high with blood vessel diseases. Temporary disability periods also increased when comorbidities were present.
The Workers Compensation Research Institute reached similar conclusions in a 2025 study of 930,000 claims from 2015 through 2019 across 32 states involving at least seven days of disability, finding that medical payments, indemnity payments and disability duration generally increased with the number of comorbidities.
Identifying those conditions can be difficult because specialists treating the compensable injury may not report unrelated diagnoses to the workers comp insurers, Mr. Williams said.
Comorbidities can slow healing, increase pain and complicate medication management, particularly when injured workers take medications for several conditions, Ms. Sacalis said.
“When you’re adding pain medications, sleep medications and a variety of different medications,” the result can be polypharmacy, she said, making information about treatment outside the workers comp claim important to managing recovery.
She highlighted a case involving an injured worker with multiple traumatic injuries and comorbid conditions who was taking more than 50 medications. The regimen included opioids, benzodiazepines and psychiatric medications, creating risks of sedation, respiratory depression and cognitive problems, she said.
The worker’s medications burden also contributed to fatigue and difficulty processing information, which affected his ability to keep appointments and participate in physical therapy, she said.
Another case involved an older worker with a low back injury whose heart disease, sleep apnea and history of substance misuse complicated medication management. Limited home support contributed to missed doses and medication misuse, and the claim continued longer, Ms. Sacalis said.
The cases illustrate why early identification, medication review, data analytics and case management are important when comorbidities are present, the panelists said. Many claimants need gentle reassurances and education regarding comorbid health conditions, they said.
“When we are thinking about these patients … we are talking about the person,” Mr. Williams said. “They are not a list of diagnoses.”
Case managers can be particularly important for coordinating treatment among multiple providers and identifying issues that otherwise may not appear in a workers comp file, he said.
Medical record reviews can also reveal conditions workers may not disclose, while medication reconciliation and deprescribing can reduce potentially dangerous combinations and make treatment regimens easier for injured workers to follow, Ms. Sacalis said.
“We need to work together to be more collaborative and coordinated,” she said.
This article was first published by Business Insurance.
