Reclassification of Obesity and Changes to The Manual of Mental Disorders

Reclassification of Obesity

In June 2013, the American Medical Association (AMA) officially reclassified obesity as a disease state, sending the message that obesity is a medical condition that warrants insurance coverage for all aspects of prevention and treatment. This message was received loud and clear by employers and insurers, who immediately began questioning how, exactly, this reclassification would impact their bottom lines. While insurers may face increased costs in the short term and employers can expect to see new types of claims, recognizing obesity as a treatable disease will ultimately help change the way insurers, medical providers, and the community view a serious condition that, according to the Centers for Disease Control and Prevention (CDC), affects more than one in three Americans.

Historically, obesity has been classified as a co-morbidity, a condition that occurs at the same time but usually independent of another injury or illness. Without an accompanying medical condition (diabetes, for example), insurance policies generally excluded treatment for obesity itself. Because obesity was a mere co-morbidity, not a disease, it was not a reimbursable Current Procedural Terminology (CPT) code, as defined by the AMA. Therefore, if a doctor wanted to talk to a patient about losing weight, the doctor would not necessarily be reimbursed by the insurance company. In the past, doctors might include an obesity co-morbidity code on the medical bill if the patient's obesity needed to be addressed in order to treat another injury or condition, or in order for the patient to recover. However, at least in the context of workers' compensation claims, obesity was not frequently deemed a condition that needed to be addressed in order to treat most work injuries or illnesses.

This shift in the AMA's classification of obesity is more than just semantics. The AMA, the nation's largest physician group, seems to be shining the spotlight on the obesity epidemic in order to encourage all health care players to focus on treatment and preventative care. Not only will the reclassification help to focus the attention of physicians on the problem of obesity, but hopefully it will spur insurers to cover prescription drugs, surgery and counseling geared toward treating obesity. If so, doctors will be able to spend time with their obese patients discussing the condition, as well as refer these patients to weight loss programs and nutritionists ' and that care will be covered by insurance. These programs designed to treat obesity may also help in the fight against Type II diabetes and heart disease, which are closely linked to obesity.

Significantly, research suggests that the reclassification will likely result in an influx of work injury claims involving obesity, as well as an increase in the number of cases in which obesity is claimed as a compensable consequence of injury.

As a co-morbidity, obesity in workers' compensation claims has been largely unreported. In other words, medical providers tend only to document injuries and conditions they intend to treat. In 2011, the California Workers' Compensation Institute (CWCI) published a study of 1.2 million claims from accident years 2005 to 2010, in which it found that although 28% of workers reported that they were obese, only 0.9% of the job injury claims from those workers included an obesity co-morbidity diagnostic code. The CWCI also found that paid losses on claims with an obesity co-morbidity averaged $116,437 ' 81% more than those claims without an obesity co-morbidity. Moreover, claims with an obesity co-morbidity averaged 35 weeks of lost time, 80% more than the 19-week average for claims without the obesity co-morbidity. See, “Obesity as a Medical Disease: Potential Implications for Workers' Compensation,” CWCI.

These numbers reveal that claims with an obesity co-morbidity have significantly higher rates of lost time from work, permanent disability, attorney involvement, additional co-morbidities (i.e., arthritis and hypertension), and more prescriptions ' all of which are associated with higher claims costs.

The AMA's reclassification may also result in protection for obese employees under the ADA, which states that employers cannot discriminate against employees on account of a disability. The ADA defines “disability” as “a physical or mental impairment that substantially limits one or more major life activities.”

Historically, an obese individual needed to have a resulting condition, such as diabetes or high blood pressure, to qualify as having a disability under the ADA; obesity alone was not protected from discrimination by the ADA. Now, obese employees are more likely to be recognized as disabled and as having rights under the ADA because the ADA's definition of “disability” encompasses virtually any diagnosed medical condition. Thus, obesity may be seen as a condition that employers need to accommodate. Also, the ADA may end up protecting obese employees from termination and other adverse actions related to the disease.

Employers would be wise to seriously consider how they can accommodate obese employees. Now that obesity is classified as a disease under the ADA, it will be difficult for employers to argue that obesity does not constitute an impairment.

Moreover, even if an employee's obesity seemingly does not affect a major life activity or body function, he might still be protected by the law if the employer regards the employee as impaired by his weight. Making changes to offices and workspaces in order to create a more comfortable working environment for all employees is a small price to pay when compared to the cost of defending ADA claims.

The reclassification may result in more workers' compensation claims and ADA claims involving obesity, which could lead to increased costs for employers and insurers. However, over the long term, the goal is that everyone will save by having fewer obese people seeking treatment for associated conditions such as diabetes and cardiovascular disease. Hopefully the change in the definition of obesity will lead to greater reimbursement by insurance companies for services provided by doctors treating people with weight issues.

Although the reclassification is not a legal decision that compels insurers to cover treatment or medications for obesity, the AMA does carry significant weight in the medical community as an authoritative body and often influences lawmakers. With any luck, the reclassification will serve as an impetus for insurers to broaden their coverage for obesity treatments, counseling, medication, and surgery, which will, in turn, decrease the nation's health costs in treating conditions such as diabetes, heart disease, and high blood pressure.

Next month, we will discuss reclassifications of psychiatric disorders and their possible effects on franchise employers.

Frank Cragle and Jaime Wisegarver are attorneys in Richmond, VA's Hirschler Fleischer. They practice in the Litigation Section and are members of the firm's Insurance Recovery Group. Cragle may be reached at 804-771-9515 or [email protected]. Wisegarver may be reached at 804-771-5634 or jwisegarver@ hf-law.com.

Part One of a Two-Part Article

The Patient Protection and Affordable Care Act (ACA) is not the only health care challenge facing employers. Recent medical disease reclassifications are affecting a large portion of America's workforce, and the long-term impact is proving difficult to predict. These changes may result in an increased number of workers' compensation and Americans with Disabilities Act (ADA), 42 U.S.C. '12101 et seq, discrimination claims, but hopefully, they will also result in a greater emphasis placed upon prevention and treatment.

While this article analyzes the recent reclassifications and provides recommendations to employers, ultimately, the impact of the reclassifications will likely be decided by the courts.

Reclassification of Obesity

In June 2013, the American Medical Association (AMA) officially reclassified obesity as a disease state, sending the message that obesity is a medical condition that warrants insurance coverage for all aspects of prevention and treatment. This message was received loud and clear by employers and insurers, who immediately began questioning how, exactly, this reclassification would impact their bottom lines. While insurers may face increased costs in the short term and employers can expect to see new types of claims, recognizing obesity as a treatable disease will ultimately help change the way insurers, medical providers, and the community view a serious condition that, according to the Centers for Disease Control and Prevention (CDC), affects more than one in three Americans.

Historically, obesity has been classified as a co-morbidity, a condition that occurs at the same time but usually independent of another injury or illness. Without an accompanying medical condition (diabetes, for example), insurance policies generally excluded treatment for obesity itself. Because obesity was a mere co-morbidity, not a disease, it was not a reimbursable Current Procedural Terminology (CPT) code, as defined by the AMA. Therefore, if a doctor wanted to talk to a patient about losing weight, the doctor would not necessarily be reimbursed by the insurance company. In the past, doctors might include an obesity co-morbidity code on the medical bill if the patient's obesity needed to be addressed in order to treat another injury or condition, or in order for the patient to recover. However, at least in the context of workers' compensation claims, obesity was not frequently deemed a condition that needed to be addressed in order to treat most work injuries or illnesses.

This shift in the AMA's classification of obesity is more than just semantics. The AMA, the nation's largest physician group, seems to be shining the spotlight on the obesity epidemic in order to encourage all health care players to focus on treatment and preventative care. Not only will the reclassification help to focus the attention of physicians on the problem of obesity, but hopefully it will spur insurers to cover prescription drugs, surgery and counseling geared toward treating obesity. If so, doctors will be able to spend time with their obese patients discussing the condition, as well as refer these patients to weight loss programs and nutritionists ' and that care will be covered by insurance. These programs designed to treat obesity may also help in the fight against Type II diabetes and heart disease, which are closely linked to obesity.

Significantly, research suggests that the reclassification will likely result in an influx of work injury claims involving obesity, as well as an increase in the number of cases in which obesity is claimed as a compensable consequence of injury.

As a co-morbidity, obesity in workers' compensation claims has been largely unreported. In other words, medical providers tend only to document injuries and conditions they intend to treat. In 2011, the California Workers' Compensation Institute (CWCI) published a study of 1.2 million claims from accident years 2005 to 2010, in which it found that although 28% of workers reported that they were obese, only 0.9% of the job injury claims from those workers included an obesity co-morbidity diagnostic code. The CWCI also found that paid losses on claims with an obesity co-morbidity averaged $116,437 ' 81% more than those claims without an obesity co-morbidity. Moreover, claims with an obesity co-morbidity averaged 35 weeks of lost time, 80% more than the 19-week average for claims without the obesity co-morbidity. See, “Obesity as a Medical Disease: Potential Implications for Workers' Compensation,” CWCI.

These numbers reveal that claims with an obesity co-morbidity have significantly higher rates of lost time from work, permanent disability, attorney involvement, additional co-morbidities (i.e., arthritis and hypertension), and more prescriptions ' all of which are associated with higher claims costs.

The AMA's reclassification may also result in protection for obese employees under the ADA, which states that employers cannot discriminate against employees on account of a disability. The ADA defines “disability” as “a physical or mental impairment that substantially limits one or more major life activities.”

Historically, an obese individual needed to have a resulting condition, such as diabetes or high blood pressure, to qualify as having a disability under the ADA; obesity alone was not protected from discrimination by the ADA. Now, obese employees are more likely to be recognized as disabled and as having rights under the ADA because the ADA's definition of “disability” encompasses virtually any diagnosed medical condition. Thus, obesity may be seen as a condition that employers need to accommodate. Also, the ADA may end up protecting obese employees from termination and other adverse actions related to the disease.

Employers would be wise to seriously consider how they can accommodate obese employees. Now that obesity is classified as a disease under the ADA, it will be difficult for employers to argue that obesity does not constitute an impairment.

Moreover, even if an employee's obesity seemingly does not affect a major life activity or body function, he might still be protected by the law if the employer regards the employee as impaired by his weight. Making changes to offices and workspaces in order to create a more comfortable working environment for all employees is a small price to pay when compared to the cost of defending ADA claims.

The reclassification may result in more workers' compensation claims and ADA claims involving obesity, which could lead to increased costs for employers and insurers. However, over the long term, the goal is that everyone will save by having fewer obese people seeking treatment for associated conditions such as diabetes and cardiovascular disease. Hopefully the change in the definition of obesity will lead to greater reimbursement by insurance companies for services provided by doctors treating people with weight issues.

Although the reclassification is not a legal decision that compels insurers to cover treatment or medications for obesity, the AMA does carry significant weight in the medical community as an authoritative body and often influences lawmakers. With any luck, the reclassification will serve as an impetus for insurers to broaden their coverage for obesity treatments, counseling, medication, and surgery, which will, in turn, decrease the nation's health costs in treating conditions such as diabetes, heart disease, and high blood pressure.

Next month, we will discuss reclassifications of psychiatric disorders and their possible effects on franchise employers.

Frank Cragle and Jaime Wisegarver are attorneys in Richmond, VA's Hirschler Fleischer. They practice in the Litigation Section and are members of the firm's Insurance Recovery Group. Cragle may be reached at 804-771-9515 or [email protected]. Wisegarver may be reached at 804-771-5634 or jwisegarver@ hf-law.com.