Business Insurance
Full article on: businessinsurance.com
By: Louise Esola
Diabetes, among the most common comorbidities seen in injured workers, can disrupt a claim’s trajectory, causing delays in recovery and higher medical expenses, according to workers compensation claims experts.
The disease, which affects the way sugar is processed in the bloodstream, can drastically affect the way a person heals, as open-wound infections are common among diabetics and, in worst-case scenarios, can lead to amputations. Wound monitoring and prolonged injury recovery are common.
“Even the simplest of a cut can get as bad as any other. It could be, literally, a paper cut,” said Kim Radcliffe, Jacksonville, Florida-based senior vice president of product management at Apricus Specialty Solutions with Enlyte LLC. The claim “can completely spiral,” she added.
“Addressing the diabetes becomes as important to recovery as that worker’s comp injury,” said Dr. Mary Schellpfeffer-Capelli Boston-based vice president and national medical director for global risk solutions, workers compensation claims, at Liberty Mutual Insurance Co.
The medical profession describes type 1 diabetes as an autoimmune condition in which the body’s immune system attacks insulin-producing cells. Type 2 diabetes — which usually appears as a comorbidity in workers compensation — is classified as a metabolic disorder that begins in adulthood and affects blood and healing.
A significant factor in treatment is that injured workers often have several other comorbid conditions in addition to diabetes that must be addressed, with obesity being the most common, said Dr. Teresa Bartlett, Southfield, Michigan-based managing director and senior medical officer for Sedgwick Claims Management Services Inc. “You can’t talk about diabetes without talking about obesity,” she said, adding that the extra weight alone can affect recovery.
The industry is also seeing an uptick in requests for diabetes drugs now being used to help patients lose weight, she said.
Delayed healing
Diabetes leads to delayed healing “because we’ve got too much sugar in our blood, and that impacts the white blood cells, all the things our bodies do to help recover and heal from even daily bumps and bruises,” said Karen Thomas, Jeffersonton, Virginia-based vice president of clinical solutions at CorVel Corp.
As a result, recovery time is delayed for wounds and injuries.
Because of these issues affecting blood and circulation, diabetics are much more prone to infections, said Mariellen Blue, Wayne, Pennsylvania-based national director of case management services and product management and development for Genex, a division of Enlyte LLC.
Medical guidelines help claims handlers predict claim duration, she said, adding that for a diabetic, the extension could be weeks or months.
Complicating the issue further is that type 2 diabetics fall into two groups: those who are managing their disease versus those who are not or are unaware they have the condition. This can muddy a claim at the onset of the injury, especially if a treating physician is unaware, experts say.
While 14.7% of U.S. adults have diabetes, 22.8% of them are unaware that they have the disease, according to a U.S. Centers for Disease Control and Prevention report released in 2021.
A best practice is for a claims handler to investigate early, Ms. Blue said. “It’s really the case manager’s job to do in-depth interviews with that injured person as well as their treating physician for the compensable injury, to make sure that everybody understands anything else that we might have to consider in treating that particular individual,” she said.
Often, there’s an embarrassment factor, as diabetics who are not managing their disease are not forthcoming about their health condition, experts said.
Ms. Thomas said enlisting nurse case managers is often the solution when trying to piece together a person’s medical history.
“There’s a certain shame factor with diabetes for some, and it’s really important for the claims professional to build that trust relationship and drive open communication with that injured worker,”
she said.
Managing care
When it’s clear a claimant is diabetic, protocols run from managing prescriptions to taking into account diabetic treatment and possible adverse interactions to coordinating care with the primary physician.
Two drug classes often prescribed to injured workers — steroids for inflammation and antidepressants for pain management — can affect blood sugar and, thus, diabetes, said Silvia Sacalis, Tampa, Florida-based vice president of clinical services for Healthesystems LLC.
“Ultimately, what it boils down to is, in comp, you’ve got to be careful what you recommend and what you prescribe because if a patient has comorbidities it can worsen them, and then the claim could be taking on that additional risk, which nobody wants,” Ms. Sacalis said.
Coordination of care is an area in which the industry could improve, said Dr. Michael Choo, Walnut Creek, California-based chief medical officer of workers compensation for Paradigm, saying diabetes should be tracked early.
Lack of communication between a doctor treating a workplace injury and a doctor treating diabetes is often the case because the workers compensation industry does not want to “buy” the diabetes as part of the claim, experts said. It’s an area many say some organizations are focusing on as they address the whole person in workers comp — and not just the workplace injury.
Elizabeth Ulloa Lowry, New Orleans-based senior vice president of risk solutions for Paradigm, said the “fragmentation of care” is problematic and can lead to delays.
“If (diabetes) is not going to allow the injured worker to be able to heal from the workers compensation injury, most medical professionals and claims professionals and attorneys agree that we should do what we can to assist with the management and mitigation of those (conditions) that affect workers compensation claims,” she said.
Ms. Thomas said the industry is making the necessary shift.
“What we don’t want to do is sweep a diagnosis of diabetes under the rug because that will definitely fester and lead to bad outcomes,” she said. “It is a delicate balance between not buying a comorbidity but acknowledging a comorbidity so that that individual gets the care and support that they need.”
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