Degenerative conditions can be defined as illnesses that cause a progressive breakdown of cells, tissues, or organs over time, leading to a decline in function. These conditions can affect various parts of the body, but when discussed in the context of workers’ comp, “degenerative conditions” often refers to such conditions of the musculoskeletal variety.
While different degenerative conditions may have varying causes, the prevalence of these conditions increases with age and the wear and tear of the human body, sometimes tied to certain repetitive motions over a significant period of time.
Delineating between a work-related injury and a degenerative comorbid condition can be difficult, but recent data make it clear that the presence of degenerative conditions within claims can significantly impact claims outcomes and costs.
With this in mind, what do workers’ comp stakeholders need to know about degenerative conditions?
The Prevalence and Impact of Degenerative Comorbid Conditions in Workers’ Comp
The Workers’ Compensation Research Institute (WCRI) found that degenerative comorbid conditions are present in 18.7% of workers’ comp claims. This includes:
- Osteoarthritis, found in 9.7% of claims
- Spondylosis (with or without nerve involvement), found in 6.2% of claims
- Degenerative disc disease, found in 5.6% of claims
- Spinal stenosis, found in 4.2% of claims
While this is not an exhaustive list of common degenerative conditions, the WCRI did find that average costs and temporary disability duration for claims with these degenerative comorbid conditions were much higher than claims without them.
Additionally, among claims involving back and shoulder injuries, those with a degenerative comorbid condition are 58% more likely to become a high-cost claim – with medical payments in excess of $65,000 within 36 months of injury.
