Written by Daniel Parks, MD | March 8, 2024

What are comorbid conditions?

Chronic underlying illnesses or conditions such as obesity, arthritis, asthma, chronic obstructive pulmonary disease (COPD), diabetes, hypertension, tobacco use, substance abuse, depression, anxiety, and other workplace mental health problems are all examples of common comorbidities or comorbid conditions. These are generally long-term health conditions that can either accompany or affect the primary injury and negatively impact a worker’s recovery and the workers’ compensation claim. 

The Centers for Disease Control and Prevention (CDC) reports that almost 52% of Americans have been diagnosed with at least one of the top 10 chronic conditions. The National Council of Compensation Insurance (NCCI) looked at the impact of comorbidities on workers’ compensation claims in a 2012 research study . According to this study, the percentage of workers’ compensation claims with a comorbid diagnosis, such as diabetes, hypertension, or obesity, increased from 2.4% to 6.6% between the years 2000 and 2009. The progression of illness rates among the general population is thought to be the major cause of the observed increase. For example, data from the CDC between 2000 and 2009 show an increase in diabetes from 4.4% to 6.7%, hypertension from 25.6% to 29.7%, and obesity from 20.1% to 27.2% within the United States general population. A rapidly aging workforce, poor nutrition, and a lack of physical activity are all reasons we are seeing a rise in chronic conditions throughout the country.

A comorbid diagnosis in a workers’ compensation claim is most predictive of lost time from work. If an obese worker is injured on the job, they are likely to miss 13 more days of work compared to another worker who is not obese. If they also have diabetes, which is more prevalent in those who are obese, their recovery could be even longer, especially after surgery, as those with diabetes often experience poor wound healing. This is only one example of a comorbid condition’s impact on a workers’ compensation claim case.

What are the impacts of comorbidities on workers’ compensation claims?

Workplace injuries with associated comorbid conditions have an adverse impact on compensable claims. Research from the NCCI shows that workers’ compensation claims involving comorbidities have almost tripled since 2000. Research has shown that injuries with comorbid conditions have higher rates of reduced work productivity from both lost time from work and reduced productivity on the job. The Centers for Disease Control and Prevention (CDC) reports that productivity losses linked to absenteeism cost employers $225.8 billion annually in the United States, or $1,685 per employee. Reduced productivity on the job costs organizations more than $150 billion annually. Furthermore, a study by Harbor Health Systems revealed that claims with multiple comorbidities experienced a 341% increase in total costs incurred.

Other challenges of workers’ compensation claims associated with comorbid conditions include:

  1. Increased complexity
  2. Higher surgery rates
  3. Longer claim duration
  4. Prolonged recovery time of the injury 
  5. More DART (days away and restricted time) days
  6. Return to work challenges and more complex accommodations
  7. Higher medical and indemnity costs
  8. Increased litigation rates

How can employers mitigate the impact of comorbid conditions on workers’ compensation claims?

1. Early identification of comorbid conditions

Identifying comorbid conditions through a comprehensive medical assessment at the onset of the injury can flag a potentially high-risk claim. Once this claim is flagged as high-risk, employers and payers can develop a comprehensive medical management protocol throughout the claim to address the injury and the comorbid condition, thereby reducing the risk of rising medical and indemnity costs. 

2. Regular monitoring

Scheduling regular follow-up with the injured worker to monitor their recovery. This regular worker interaction can identify possible complications early, assist with navigating the complex workers’ compensation system, provide emotional support, and reinforce expectations of a successful recovery and return to work. Providing this level of injured-worker interaction aids the employee in feeling that their well-being matters, decreases their frustration with a complex, bureaucratic workers’ compensation system, and decreases their feelings of isolation and despair. 

3. Clinical coordination 

Having well-trained medical professionals assess and care for the injured worker early after the onset of injury and coordinate care throughout the recovery process. Taking a holistic, start-to-finish approach to the treatment and recovery plan significantly aids an individual in healing both physically and mentally. A focus on the emotional well-being of the injured worker is paramount. The sustained, negative impact of depression statistically shows injured workers with depression being 2.3 times more likely to not return to their pre-injury work status or pre-injury levels of function at one-year post-injury.

4. Wellness programs

Providing health education, injury/illness prevention, and mental health support services available and accessible before, during, and after injury. Studies have shown a direct correlation between effective employee wellness programs and the reduction of workers’ compensation and disability management claims by 30%. A healthy employee will recover quicker from an injury than one with a comorbid condition. Encouraging an employee to improve their health by offering preventive health screenings (hypertension, dental, diabetes, cholesterol, etc.), on-site wellness activities (medical tip of the week, occupational athlete program, stretch and flex, walking groups, etc.), and routine encouragement of employees to make healthy lifestyle choices through better nutrition, increased exercise, and mental health care.

How can JobSiteCare improve the management of workers’ injuries with comorbid conditions?

JobSiteCare can offer an effective, cohesive solution that optimizes health outcomes and operational efficiency. With JobSiteCare, you gain a partner committed to offering a comprehensive approach to workplace injury management services, from the moment of injury through return to work, all coordinated by board-certified physicians. We are dedicated to injured workers’ recovery and rapid return to work. Our innovative approach integrates telemedicine into workers compensation procedures and combines immediate telemedical triage, diagnosis, guided treatment, regular follow-up, and case management, all conveniently delivered at the job site. JobSiteCare employs evidence-based medicine guidelines and predictive analytics to determine which cases may be high-risk and, in partnership with the employer’s claims department, formulates a comprehensive management plan. JobSiteCare can be instrumental in instituting employee wellness programs such as the occupational athlete, smoking cessation, weight management, stretch-and-flex, and ergonomic assessments. These proactive wellness programs can minimize potential side effects from comorbid conditions and improve the health of the workforce. 


A healthy workforce is critical to an organization’s daily operations. When an employee suffers a work-related injury, ensuring their successful recovery and safe return to the workforce should be paramount to the employer. This successful recovery and safe return to the workforce can be complicated by underlying comorbid conditions that can affect the injured worker’s treatment and recovery. Early identification and awareness of comorbid conditions with work-related injuries provide a holistic view of the workers’ health, thereby allowing a more comprehensive treatment plan addressing both the injury and the comorbid condition. This comprehensive treatment plan will likely contain medical costs and improve outcomes. Applying these in an interdisciplinary approach to case management will help mitigate spiraling costs, improve outcomes, decrease DART days, and improve the health of the workforce.


  1. Law, C., & Colon, D. (2012). Comorbidities in Workers’ Compensation. NCCI.
  2. ODG announces comorbidity calculator [press release]. Encinitas, CA: Work Loss Data Institute; April 10, 2010. http://www.odg-twc.com.
  3. January 2015. CDC Foundation. Worker Illness and Injury Costs U.S. Employers $225 Billion Annually.  https://www.cdcfoundation.org/pr/2015/worker-illness-and-injury-costs-us-employers-225-billion-annually.
  4. Schill AL, Chosewood C. Manager’s Buzz.  Total Worker Health in Action: Centers for Disease Control and Prevention [serial online]2012 October; 1(3). Available at:https://archive.cdc.gov/www_cdc_gov/niosh/twh/newsletter/twhnewsv1n3.html.
  5. Richmond JD, Guo W, Ackerson T, et al. The effect of post-injury depression on return to pre-injury function: a prospective cohort study. Psychol Med. 2009; 39(10): 1709-1720.