Cigna Study Tracks Short-Term Disability Claims

20 years of data highlight workforce productivity challenges

An analysis of 20 years of Cigna's short-term disability claims shows that absences related to obesity, treatment for skin cancer, and herniated disc surgery increased significantly from 1993 to 2012.

The study also found a reduction in absences related to depression coupled with an increase in prescribed antidepressants, which may signal an underlying problem of presenteeism.

Presenteeism, defined as sick or distracted employees who choose to work anyway, accounts for 39.4 percent of the total cost of obesity to employers1 and as much as 75 percent of lost employee productivity from U.S. employers.2

These and other health trends identified by the Cigna study are important for local government to consider when structuring an integrated wellness and absence management program to improve health and workforce productivity.3

"Employers who focus on productivity as an outcome will succeed in the future. Though medical advances have helped improve the quality of life for many people, lifestyle and behavioral factors remain key drivers of abseentism," said Robert Anfield, MD, chief medical officer for Cigna's disability insurance unit. "Employers must address these triggers earlier with intervention, vocational rehabilitation services, and wellness programs."

Workforce Productivity Challenges

The U.S. Bureau of Labor Statistics reports that American businesses lose an average of 2.8 million work days each year due to unplanned absences, costing employers more than $74 billion.

The most frequently approved shortterm disability claims, both 20 years ago and today, remain musculoskeletal disorders, which make up 25 percent of all non-maternity absence. While some diagnostic categories in this grouping benefit from medical advances, others are impacted by changing demographics and underlying health.

"The aging workforce and a trend toward growing waistlines has made some medical conditions more dominant factors for short-term disabilities than they were 20 years ago," said Anfield. "For example, arthritis and tendonitisrelated absences have both increased more than 50 percent since 1993."

The study, however, found significant changes in short-term disability rates for obesity, cancer, depression, and herniated discs that highlight the impact of medical advances on absence and productivity.

Herniated Discs. As new techniques have improved the efficacy of back surgery, the number of procedures has gone up and the average amount of time out of work has decreased. Simultaneously, these medical advances have led to an increase in the number of eligible candidates for surgery and an overall net increase in lost productivity time.

Cigna data show a 45 percent increase in work absence for herniated discs, which represents the most significant increase in short-term disability claims among sedentary occupations during the 1993 to 2012 period.

Local governments should consider implementing programs that target specific conditions. For those individuals who may not need surgery, you may want to take a fresh look at the employee's workstation and other factors that can contribute to back and muscle issues. For those who require surgery, vocational rehabilitation programs are designed to help individuals successfully reenter the workforce.

"The rise of vocational rehabilitation services and improvements in returnto-work programs over the past 20 years helped individuals return to work faster," Anfield said. "Employers need to understand that as medical treatments improve, the number of employees in need of programs to help them stay at work or return to work increases."

Obesity. Over the past 20 years, the number of obese Americans has doubled. At the same time, short-term disability claims related to obesity have increased by 3,300 percent, according to Cigna's study. Many of these absences can likely be attributed to the increasing effectiveness and popularity of bariatric surgeries. This rise in the percentage of obesity claims, however, does not reflect the impact of such chronic conditions linked to obesity as diabetes and some musculoskeletal conditions.

Absence isn't the only worry when it comes to obesity. Individuals suffering from obesity may avoid changes in lifestyle, which can lead to an increase in physical and mental challenges, such as the onset of depression.

Although bariatric surgery has improved the lives of many people, it can only be as effective as the healthy lifestyle changes the individual adopts after surgery. In some cases, individuals who fail to change habits find the success of the surgery won't last long. Employers that provide resources and coaching, such as employee assistance programs (EAP) and vocational rehabilitation services, can help employees become more productive and enjoy long-lasting health.

Cancer. According to the American Cancer Society, this year there will be an estimated 1.7 million new cancer cases diagnosed.4 Among different types of cancers affecting short-term disabilities, the biggest spike during the 20-year period of the study was due to skin cancer-now five times more prevalent than in 1993. Skin cancer is the leading cause of cancer for individuals in the 25 to 29 age group as sun exposure and tanning represent significant risk increases.

Overall, cancer screening and advances in medical treatment have reduced the number of cancer-related deaths and the duration of cancer-related disability claims. More survivors are now able to return to work, but employers should implement absence management strategies that integrate wellness programs, disease management programs, and vocational rehabilitation services to meet the needs of cancer patients. Cigna's study showed that a combination of these programs helped 97 percent of survivors rejoin the workforce.

Employers should also anticipate that caregivers who look after family members with cancer will require family and medical leave (FML) time. The stress and other demands placed on a caregiver may carry a mental and physical toll. Nearly 80 percent of FML absences can also become a short-term disability event.5

According to Cigna's own study, getting a head start on engaging employees who are on FML can lead to nearly seven fewer days away from work, when an integrated disability and FML administration strategy is in place.

Depression. Twenty years ago, depression was the third leading cause of a short-term disability. Today, Cigna's claim data shows it as the fifth leading cause. While related absences have been reduced slightly, depression still has a major impact on employers' bottom lines. In fact, according to a National Institutes of Mental Health's disability study survey, depression is the leading cause of disability in the U.S. among those ages 15 to 44.

More than one-fourth of Americans ages 18 and older suffer from a diagnosable mental disorder in a given year.6 Since 1993, the use of antidepressant medications increased from 37.3 percent to 74.5 percent.7 As the underlying causes of depression are left untreated, the condition can have a significant impact on individuals' health and their workforce contributions, underscoring the importance of an employee assistance program to help people with behavioral health needs to access care.

About the Study

Cigna examined 20 years of short-term disability claim data, which provides some indicators of what has changed and what has stayed the same. Cigna's data included information on industry, occupation, plan design, diagnostic categories, and such outcomes as average duration, return to work, and total absence. The data was broken into 267 diagnostic categories.

For more about the study, visit http : //newsro om. cigna. com/20 -yeardisability-study. pyi

"Cigna" is a registered service mark of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries, including Life Insurance Company of North America, Cigna Life Insurance Company of New York, Connecticut General Life Insurance Company, and Cigna Health and Life Insurance Company, and not by Cigna Corporation. Copyright 2014 Cigna. Some content provided under license. To learn more about Cigna, including Facebook and Twitter links, visit http://www.cigna.com. Cigna is an ICMA Strategic Partner.

ENDNOTES

1 Integrated Benefits Institute Analysis 2012.

2 Health Enhancement Research Organization, 2012.

3 "Reducing the Incidence of Short-Term Disability: Testing the Effectiveness of an Absence Prediction and Prevention Intervention Using an Experimental Design," Journal of Occupational and Environmental Medicine, December 2012

4 Cancer Facts & Fgures 2014, American Cancer Society, http://www.cancer.org/research/ canee rfactsstatistics/cancerfactsfig u res2014/i ndex

5 Early Warnings: Using FMLA to Understand and Manage Disability Absence, Integrated Benefits Institute, February, 2013.

6 Mental Disorders in America, National Institute of Mental Health.

7 Depression treatment rates increase over past decade, but psychotherapy declines, Archives of General Psychiatry, 2010.

SHEILA MCGINLEY

President

Cigna for Government and Education Bloomfield, Connecticut

[email protected]; cigna.com/healthiergov