Obesity debate weighs on workers' compensation

Risk & Insurance, April 1, 2003 by Bruce Shutan

With two-thirds of the U.S. population said to be overweight and Fast Food Nation a bestseller, workers' compensation administrators face a heavy burden handling disabilities linked to fitness.

For disputes that arise in occupations that make physical fitness a condition of employment, employers may have more liability than they think.

"Employers could inadvertently become liable for claims of injuries that occur in the course of physical exercise aside from normal job duties," according to Eric Oxfeld, president of UWC Inc., a Washington, D.C.-based business group focused on workers' compensation and public-policy issues.

State laws vary in terms of recognizing underlying medical conditions, such as obesity, that are related to specific injuries and illnesses. "In order to treat a back injury," says Oxfeld, "it may be necessary to treat obesity, which can certainly affect not only the course of treatment but the length of time it takes to recover."

Richard Stephens, a spokesman for the state of California Division of Workers' Compensation in San Francisco, said a workers' comp judge described the obesity link to him as "not uncommon."

For example, doctors may prescribe a weight-reduction program for overweight claimants with back or knee injuries before agreeing to perform surgery. "The obesity isn't the cause of the injury but could be a factor in order for treatment to be covered," he says. Obesity theoretically could be raised in court as part of an employer's defense strategy if the claimant has suffered a heart attack that is being attributed to work-related stress, Stephens adds.

Healing Hindered

Obesity and related morbidity factors such as diabetes and heart conditions often contribute to a higher rate of workers' comp injuries, said Libby Child, a management specialist who used to manage workers' comp for Grand Rapids, Mich.-based Steelcase.

Child, a senior consultant with Varnum Consulting in Grand Rapids, Mich., knows of what she speaks. As someone who lost half her body weight with the help of Weight Watchers, she says the amount of time overweight employees devote to thinking about food and how they're perceived impairs job concentration. This could be a recipe for disaster, particularly for laborers working around machines.

The healing process also takes much longer for obese claimants, says Child, a claims administrator for 20 years. "Someone weighing 400 pounds who slips and fails won't be able to return to work as fast as someone who's 180 pounds," she says.

People who are overweight and physically unfit are also more prone to work accidents, according to Don R. Powell, president of the American Institute for Preventive Medicine in Farmington Hills, Mich.

"There's an emergence of research showing savings to organizations that have implemented wellness programs that include weight control as it relates to lowering workers' comp claims and producing fewer disability days," he said, citing Rochester, N.Y-based Xerox Corp., as one such example.

When Powell spoke last year at a worker's comp conference on the topic of using health promotion as a loss-control strategy, he noted that those who are at a high risk for being overweight have 21.4 percent higher health care costs than others.

That's not to say employers can't win this battle of the bulge. Consider, for instance, that when states allow employers to control decisions involving a change in medical providers for injured workers, the medical cost component of workers' comp claims may be reduced by 7 percent to 10 percent, according to a recent study by the Workers Compensation Research Institute in Cambridge, Mass.

Unless the government, the fast-food industry and schools take serious action to curb the obesity trend, former Surgeon General David Satcher warned in 2001 that it could very well surpass tobacco as the leading cause of preventable deaths in the United States.

The issue already is reshaping the workplace. "In terms of health care costs, the biggest for benefit managers is obesity--not smoking or substance abuse," according to Roland Sturm, a RAND economist and author of a landmark study on the subject published last year.