Work First Pro Tips #3: Comorbidities

“I have a new patient for you,” you tell one of your new employees over the phone. As you give your employee the name and address of the new patient, you feel confident that you’ve done all you can to provide superior care to your client. After all, you have put together a comprehensive care plan, you have inspected the home for hazards, and your new employee seems to have a stellar resume.

Before long, you receive a phone call from a hospital informing you that your employee was injured.

True Story

A home health agency secured a new elderly client needing home care services. A care plan was prepared, and a routine check was completed on the patient’s home to inspect for possible hazards that an employee might encounter while caring for the patient.

After all the preliminary checks and administrative duties had been attended to, the agency called one of their employees with the assignment of caring for the new patient. They made sure that their employee had all of her credentials in place and was fully capable and confident to be able to perform the job safely.

In what should have been a routine job of mopping up some spilled tea, the employee carried mop water to the back porch to dump it out. The employee fell through the porch, sustaining a severe injury to her right knee and back. The injury required surgery and chiropractic care for over a full year following the incident.

What happened? All the preliminary checks were completed properly. The answers didn’t come until after the medical report was filed. The employee was not a good fit for the job. Despite her credentials, it was noted that she weighed over 300 pounds.

Her weight wasn’t the only issue. The medical report revealed that she was diabetic and smoked two packs of cigarettes per day.  You may be asking, “What does her weight, diabetes and smoking habit have to do with this claim?”

In medicine there is a concept called comorbidity where the presence of one or more additional disorders (or diseases) co-occurring with a primary disorder.  In this case the knee and back injury were the primary disorders, and her weight, history of smoking and diabetes are comorbidities.

Each of her comorbidities contributed to the ultimate cost of over $200,000 for this injury.  Her weight drastically increased the severity of the injury to her knee.  The diabetes significantly increased her recovery time due to reduced circulation in her leg, and the two-pack-a-day smoking habit further contributed to reduced nutritional blood flow needed to repair her knee following surgery.

Pro Tip:

When selecting employees, a company must consider more than what they see on the application.

When interviewing a prospective employee in person, you can take a mental note of some of the obvious comorbidities that might negatively affect the suitability of a prospective employee.. In this case a well-trained and experienced interviewer would’ve instantly seen that the candidate was a frequent smoker and weighed over 300 pounds. For a physically demanding job like being a home health aide, a pre-employment physical examination is also an effective tool in assisting in identifying factors that might negatively affect an employee’s ability to safely perform the job

Some comorbidities are visible while others are not. However, as an interviewer, it’s always helpful to be knowledgeable about the signs of various comorbidities that could affect the suitability of a prospective employee for performing the jobs you have available.

It is your responsibility to ensure that an employee is physically capable of performing the job, and assessing not only what is on the application, but what you observe is should be critical part of your employee onboarding process.

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Work First Casualty Company is proud to announce that we’ve expanded our borders! We are prepared to begin serving in North Carolina with the same high-quality service that you come to expect from us on February 1, 2016. Discover what a Work First Casualty Company policy can do for you by contacting Bruce Winterrowd, Vice President of Underwriting and Marketing at (630) 416-7594 or by email at

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