The cost of health insurance in the United States has been rising steadily for decades. In 2021, the average annual premium for employer-sponsored health insurance was $7,739 for single coverage and $22,827 for family coverage. These costs are surpassing wage growth, meaning that workers are devoting a greater portion of their income to health insurance. As noted in the September 8 Wall Street Journal, the growth of health insurance costs will display some of the most significant increases in over a decade. Moreover, even those acquiring insurance through the Affordable Care Act (Obamacare) are confronting a 6% increase in premiums. This trend carries several adverse consequences for workers’ compensation.

First, aside from the question of who bears the increased cost or whether the additional expense will lead to lower take-home wages, one of the primary concerns is that an increasing number of employees may become uninsured, as there seems to be no alternative but to take chances with one’s health. Considering that the number of uninsured workers exceeded 25% in the last reported statistics, the calculation of rising health insurance expenses translates to a larger uninsured workforce. The key point to note is that with a growing uninsured workforce, this does not correlate with a reduction in acute and chronic health issues, particularly in a population that is increasingly noted to be obese.

What does this mean for the workers’ compensation system? It is becoming a trend to connect common health concerns associated with the challenges of everyday life to compensable event. The mantra of “My back didn’t hurt before, but it hurts now” doesn’t hold up when dealing with conditions like multiple-level spondylosis or degenerative disc disease, especially when there is no remaining intervertebral disc space.

Clearly, as indicated in the Grand Bargain, we hired that individual as they were. However, if that individual was hired ten years ago and is now morbidly obese, diabetic, and served our country honorably by parachuting from aircraft 25 years ago, is their knee pain a result of sitting at a desk and bumping their knee against a file cabinet two days ago? This is not to say that there are no health concerns, only that these issues are not a result of an acute event.

More frequently, jurisdictions are making it more challenging to exclude complications arising from ordinary life scenarios from the compensable event. Therefore, it becomes increasingly important for the claim file handler to meticulously examine the reported mechanism of injury and the provided complaints, and thoroughly review the individual’s past medical history, the review of systems, and the physical examination reported by the initial evaluator. At this point, it is essential for all participants in the workers’ compensation system to adhere to noted best practices, address and treat the effects of the injury as promptly and comprehensively as possible, and inform the injured individual that certain clinical findings are not related to this specific injury.