The Overlooked Factors That Can Influence an Injured Worker’s Recovery

Recent studies show that up to 4-in-10 lost-time claims involve at least one pre-existing condition, like diabetes or mental health conditions. These conditions can make an injured worker’s recovery increasingly difficult, resulting in a delayed return to work.

“A lot of organizations want to know the most impactful pre-risk condition for poor recovery, but there is not one singular answer,” said Stacy Whalen, Medical Management Director at Safety National. “It is important to not only understand the clinical history but also the behavioral and social determinates of health that could impact recovery.”

Here we discuss possible pre-risk conditions that could impact the overall trajectory of an injured worker’s healing.

Physical Health Factors That May Slow Injured Workers Recovery

Certain physical health conditions might extend recovery time and delay an employee’s return to work.

1. Diabetes – Diabetic patients are at a higher risk for postoperative recovery and wound healing complications due to poor vascularization and a weakened immune system.
2. Obesity – Excess weight places high stress on healing joints and muscles while making recovery activities, like physical therapy or rolling themselves in a wheelchair, more difficult. Obesity is also linked to conditions like diabetes and hypertension, which directly suppress the body’s immune response.
3. Cardiovascular health – An injured worker with poor cardiovascular health may be compromised by reduced blood flow, oxygen deprivation, and chronic inflammation. These combinations can lead to higher risks during surgery, blood clots, and physical decline during recovery.
4. Chronic pain – Individuals with chronic pain typically have exaggerated pain signals since their nervous system is already sensitized. Additionally, constant experience of pain triggers psychological stress, which negatively impacts the body’s healing capacity.

Behavioral and Mental Health Considerations

While physical health is an important consideration for recovery time, it is only part of the story. Two employees could experience the same injury, but their behavioral and mental perspective on the situation could differ completely. This is why understanding an injured worker’s mental and behavioral history can significantly change the way treatment is handled.

1. Depression – A lack of motivation and energy could lead to skipped medical appointments, neglected at-home rehabilitation, and poor lifestyle choices that further disrupt recovery.
2. Bipolar Disorder – Psychological stress and physical pain can trigger bipolar mood episodes, which could derail rehabilitation efforts. Impaired adherence to medical regimens and certain pain medications interfere with bipolar medications, altering their effectiveness or causing toxicity.
3. History of alcohol abuse – According to the National Library of Medicine, acute and binge alcohol exposure can lead to several complications, such as impairing bone fracture healing and tissue repair, and increasing the risk for incurring a traumatic injury.

Social Determinants of Health and Recovery Barriers

Social determinates of health (SDoH) are another important consideration in an injured worker’s recovery journey. SDoH are nonmedical conditions that shape the environments where people are born, live, work, and age — all of which affect the ability to heal or access care. Categories that could impact the trajectory of an injured worker’s recovery include:

1. Housing – Many injured workers may be displaced during recovery or return to homes that are no longer accessible due to their injury. These housing challenges can add significant stress to an already difficult recovery and create additional barriers to healing. Carriers can help by connecting injured workers with services that make their recovery environment more manageable through home modifications.
2. Economic stability – An injury can disrupt a worker’s finances during treatment. Even if the employer’s workers’ compensation carrier covers medical costs, any loss of income can affect the worker’s financial stability after recovery. This makes it even more important for employers to choose a carrier that prioritizes the most efficient treatment plan possible.
3. Education – Understanding the healthcare system, especially the workers’ compensation process, can improve an injured worker’s engagement in their recovery. Because many employees are unfamiliar with how it works, clear communication from the carrier can make a meaningful difference.
4. Lifestyle – Daily habits and routines can affect recovery time. Understanding an injured worker’s environment and barriers can help medical providers improve adherence, prevent early discharge, and reduce the risk of reinjury or a reopened claim.
5. Culture – Care should reflect an injured worker’s cultural preferences and comfort level. Carriers can support better outcomes by recognizing when treatment may conflict with those preferences and helping coordinate appropriate adjustments.

How Excess Carriers Can Support a Smoother Recovery

Excess carriers specializing in catastrophic claims understand the factors that drive successfully claim outcomes. In response, they know prioritize early collaboration, bringing stakeholders as soon as an injury occurs to identify potential recovery barriers. Throughout treatment, excess carriers rely on experts such as medical management teams, third-party administration (TPA) claims adjusters, field nurse case managers, and claims managers. Together, these experts focus on the whole person — considering physical, behavioral, medical, and social factors that influence recovery. Additionally, an excess carrier’s medical resources and third-party vendors can directly influence the quality and speed an injured worker’s treatment.