Is the Juice Worth the Squeeze?

Do you guys like pomegranates? I do, but I don’t like the work it takes to eat them. It’s like the fruit equivalent of multi factor authentication…so many steps! I don’t even want it anymore! I’ll just eat an apple.

Sometimes, that’s what if feels like to pursue apportionment on a work comp claim.

If you’re unfamiliar with the concept of apportionment, it’s like splitting the bill for a worker’s permanent disability when more than one cause is involved. Let’s say an employee has permanent disability from a back injury at work, but they also have a back injury from an old college football injury. The employer only has to pay for the portion of permanent disability caused by the work injury. So, if only 60% of the permanent disability is due to the work injury, the employer doesn’t have to pay for the remaining 40%. Cost savings!

Except…it’s like eating a pomegranate. It takes a lot of time and money to obtain the information needed to prove apportionment exists: subpoenaed records, depositions, medical-legal evaluations, etc.

Even after all that, you can’t be certain until after discovery is completed whether the cost savings realized will be greater than the costs spent on discovery.

Let’s assume the best-case scenario: your cost savings on permanent disability is greater than the cost of discovery. Success! Right?

Kind of. The bigger challenge is that it is more common for an employee to have chronic co-morbidities than a specific pre-existing injury. Issues such as osteoarthritis, obesity, diabetes, degenerative disc disease, history of smoking or substance abuse can complicate and prolong medical treatment and the duration of temporary disability, but only permanent disability is apportionable.

Don’t get me wrong, it’s still important to pursue apportionment on your work comp claims, but if you are an employer, you’ll get more bang for your buck if your employees are actively engaged in their health and preventative care before an injury occurs. The WCRI recently published a report indicating 18% of claims include a pre-existing degenerative co-morbid condition, and the existence of just one co-morbid condition can double the medical and temporary disability costs.

At the end of the day, apportionment can feel like cracking open that pomegranate. You might get a few juicy seeds, but you’ve also made a huge mess along the way. For employers, the real win isn’t always in chasing down every ounce of apportionment, but in investing in prevention and overall employee wellness from the start. Healthier employees mean fewer complications, faster recoveries, and ultimately lower claim costs.