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  • Comorbidity and Injured Individuals: Part one

    Oct 09, 2019
    • Medicare Insights
    • The Policy Matters team

    Comorbid conditions in workers’ compensation and auto no-fault can create a trifecta of negative outcomes and aggravate an already difficult situation for an injured individual. In Part one of our series on comorbidities, we will define what they are and describe the three ways comorbidities can make a bad situation worse.

    Comorbidity and injured individuals: when the egg is first, the chicken follows

    In medicine, comorbidity is defined as the presence of one or more additional conditions co-occurring with a primary condition. Relating to workers’ compensation and auto no-fault, when a person has a preexisting pathological process or processes, that individual may be predisposed to injury, treatment may be complicated, and duration of therapy extended

    THE POTENTIAL IMPACT OF A COMORBIDITY

    Longer recovery and disability duration

    This confounding of the injury may be somewhat intuitive since signs and symptoms of disease, both physical and mental, can negatively affect the injured individual's structure and function, and contribute to distress, dysfunction and pain on its own. The relationship between comorbidity and injury has been studied and codified. For example, people with diabetes and foot ulcers[1] have an increased risk of falls and subsequent fracture. You can also see the impact of comorbidity on a forearm fracture recovery:

     

    Forearm fracture              Disability duration        

    Typical w/o comorbidity     43 days

    Diabetes coexistence        62 days

    30 days of opioids             119 – 231 days[2]


    Comorbidity medications can worsen comorbidity issues

    Beyond the disease itself, medications used to treat a comorbidity may also increase the risk of  injury. For example, antidiabetic medications may cause low blood sugar (hypoglycemia) and when severe, symptoms may include tremors, muscle weakness, blurred vision, mental confusion and loss of consciousness.

    Injuries can lead to comorbid conditions

    We have also seen the reverse situation where certain injuries are claimed to have caused related comorbidity, such as obesity and diabetes subsequent to inactivity, or PTSD from trauma. However, this series will focus on preexisting conditions worth identifying and mitigating such as psychological, metabolic and cardiovascular that may impact the workers’ compensation and auto no-fault claim.

    Coming up

    Over the next month, we’ll release a blog post each week covering four comorbid conditions that can negatively impact workers’ compensation and auto no-fault cases: mental health  issues, hypertension, respiratory issues, and diabetes/ obesity. 

    Sources:

    [1] Wallace C. Diabetes Care 2002 Nov; 25(11): 1983 1986. https://doi.org/10.2337/diacare.25.11.1983

    [2] Official Disability Guidelines. Comorbidity Calculator. Available on subscription at: https://www.mcg.com/odg/ Accessed Feb 26, 2019.


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