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April 29, 2019
Anxiety, depression add to workers’ compensation costs

Having to treat anxiety or depression in injured workers along with physical pain can significantly increase both the costs of workers’ compensation claims and the time away from work, a new study found.

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Prescriptions for antidepressants, benzodiazepines, and opioids to treat all three conditions led to the highest medical costs and slowest closures, according to a report in the Journal of Occupational and Environmental Medicine.

Researchers investigated claims and prescription information for a cohort of 22,383 claims from Accident Fund (AF) Group, a workers’ compensation insurance carrier. The claims were reported between 2008 and 2013 and followed until December 31, 2017.

Multiple drugs, higher costs

Workers’ compensation claims involving no prescription medications have the lowest costs and fastest closures. During the period studied, 91.8% of claims without any drugs had closed. The more drug types prescribed, the higher the costs and the lower the closure rate:

  • Average medical cost for claims with opioids alone was $28,563 with a closure rate of 89.1%;
  • Average cost of a combination of benzodiazepines and opioids was $53,366 with a closure rate of 75.8%;
  • The combination of antidepressants and opioids resulted in average medical costs of $64,507 with a 64.8% closure rate;
  • The average cost of claims with antidepressants, benzodiazepines, and opioids was $93,667 with a closure rate of 58.3%.

Few claims in the cohort involved prescriptions for antidepressants or benzodiazepines alone, or a combination of the two.

Expected results

The researchers were unsurprised by the results. Previous studies had found that adding a benzodiazepine prescription to an opioid prescription both increased medical costs and delayed the return to work.

“What did surprise us is the increased recovery time and medical costs associated with antidepressant medications,” Dan Hunt, DO, coauthor and medical director at AF Group, said.

Studies in general medical literature show generally higher costs for medical care for people with psychological disorders. The costs of simultaneously treating physical and psychiatric conditions are comparatively higher.

Data from the AF Group database system were used in the study. Information on prescriptions of opioids, antidepressants, and benzodiazepines was evaluated for the first 3 years after the date the injury was reported.  Because the study included claims with injury dates between 2008 and 2013 with follow-up to December 31, 2017, the shortest claim-development period investigated was 4 years.


The use of opioids to treat pain has changed since 2013. The Centers for Disease Control and Prevention (CDC) issued new guidelines in 2016 for prescribing opioids for treatment of chronic pain. The CDC guidelines recommended a reduction in both number and strength of opioid prescriptions. The guidelines are part of a wider effort to find alternative, nonopioid treatments for chronic pain.

However, the recent study reveals that treatment for depression along with pain both increases costs and delays closing workers’ compensation cases.

The new findings allow adjusters and claims managers to anticipate higher costs when anxiety or depression occurs along with chronic pain. The presence of prescriptions for antidepressants along with opioids should alert claims administrators to higher costs and delayed case closure.

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