Len is one year away from his 30-year anniversary with a regional manufacturing company. At 63 years old, he’s a respected warehouse supervisor known for his strong work ethic and his habit of jumping in to lend a hand whenever a co-worker needs it. The atmosphere in the warehouse was bleak when workers learned that Len had suffered a rotator cuff tear and neck strain while helping his team finish up a large inventory move.
At the start, Len’s claim appeared straightforward. The injury was well defined, treatment was initiated promptly, and there was every reason to expect a typical recovery. But as clinicians and claims professionals looked more closely, they realized Len’s claim might be more complex than it first appeared.
Len’s Situation
Len’s workers’ compensation claim is an example of a growing challenge facing employers and payers: an injured worker whose recovery is influenced not only by the injury itself, but also by the combined impact of age-related recovery challenges, co-morbid health conditions, and psychosocial barriers. When taken together, this “triple threat” has the potential to significantly increase the risk of a prolonged disability.
Age
At 63, Len’s age could significantly affect the time it takes to recover from his injuries.
Today’s workforce is older than ever before, with many employees choosing to work later into life with more demanding jobs. While older workers often experience fewer workplace injuries than their younger counterparts, recovery can be more challenging when an injury does occur. Healing may take longer, physical resilience may be reduced, and underlying age-related changes can increase the likelihood of complications or extended periods away from work. As a result, injuries that might be relatively straightforward for a younger employee can become considerably more complex for an older worker.
Comorbidities
Len has had Type 2 diabetes since the age of 55.
Many injured workers, particularly older adults, enter the workers’ compensation system with existing health conditions that can influence recovery. Conditions such as diabetes, obesity, cardiovascular disease, arthritis, hypertension, sleep disorders, and chronic pain can all affect treatment outcomes and rehabilitation progress.
For example, diabetes may slow healing, while obesity can place additional stress on injured joints and muscles. Arthritis can complicate recovery from musculoskeletal injuries, and cardiovascular disease may limit participation in certain rehabilitation activities. In many cases, these underlying conditions create additional obstacles that extend recovery timelines and increase the need for ongoing medical care.
Psychosocial Concerns
Len worries about finances and, especially now with his injury, his ability to work. He is also coping with the demands of supporting a daughter with significant health challenges of her own, which adds another layer of emotional strain.
Psychosocial issues are often the least visible, yet they can have an outsized effect on recovery. Depression, anxiety, fear of reinjury, financial stress, family pressures, social isolation, or a perceived lack of employer support can significantly influence an injured worker’s outlook and engagement in treatment.
An employee who worries about losing income, is dealing with difficult personal or family issues, or lacks confidence in their ability to return to work may struggle to make progress even after the physical injury has begun to heal. Research and industry experience have shown that these non-medical factors can become powerful drivers of claim duration and disability, sometimes exerting a greater influence on outcomes than the injury itself.
And certain types of injuries can be more likely to affect mental health. As Tron Emptage, MA, RPh, Optum Workers’ Comp and Auto No-Fault Chief Clinical Officer, points out, “In a retrospective study of 2024 workers’ compensation data, we analyzed the relationship between injury type and mental health prescriptions. Workers with multiple physical injuries were more likely to receive a prescription for a mental health medication than other types of injuries.”
Len’s Recovery Needs
For those involved in Len’s claim, it is important to note his advanced age, chronic health condition, and psychosocial concerns.
The best opportunity to influence the course of a claim often occurs during the earliest stages of recovery. By identifying risk factors such as advanced age, multiple chronic health conditions, behavioral health concerns, prior disability history, fear-avoidance behaviors, or limited social support early, employers, payers, and clinical teams can provide specific support before challenges become entrenched.
Employers and claims administrators play a critical role. Maintaining regular communication, listening carefully to the injured worker, and expressing genuine concern for the injured worker’s physical and psychological well-being can help preserve the worker’s connection to the workplace. When employees continue to feel valued and supported, they are often more motivated and confident about returning to work.
Emptage explains the need to serve as an educational and clinical resource to those who are supporting injured workers throughout recovery:
“We’re here to support our clients as they support their injured workers. Our medication formularies are tailored for workers with acute and long-term injuries to provide the right medications at the right time. We also use very sophisticated data analytics to evaluate claims and identify injured workers who are at the highest risk. Our portal provides that information to claims professionals so they can work with prescribers to make the appropriate treatment decisions and care planning.
Our clinical pharmacist liaisons provide clients with guidance on difficult claims. In addition to offering clinical recommendations to improve claim outcomes (for example, involving a nurse case manager to assist with medication adherence), we provide education through continuing education programs, podcasts, white papers, articles, and client-specific resources.”
Len’s Support System
Len, like many injured workers facing a complex recovery, needs support from different angles.
The weeks and months that follow an injury are often filled with uncertainty, setbacks, and difficult questions about health, work, finances, and the future. During this time, ongoing guidance can make all the difference.
A coordinated approach helps ensure that everyone involved in the worker’s care is moving in the same direction. Providers can address emerging issues quickly, avoid unnecessary duplication of services, and keep recovery on track. At the same time, the emotional impact of an injury should never be overlooked. Feelings of anxiety, depression, stress, or fear of reinjury can slow progress and make recovery feel overwhelming. When behavioral health support is available, workers are often better equipped to stay engaged in treatment and regain momentum.
Optum Workers’ Comp and Auto No-Fault Medical Director Robert Hall, MD, notes the importance of listening to the injured individual and tuning into their challenges:
“At Optum, we take a comprehensive approach. We realize that you can’t just treat the broken leg, the PTSD, or the pain. Along with that, you must drill deeper by asking questions such as ‘How are you doing? How are you feeling? How are you sleeping? Do you have trouble getting to your medical appointments? Are you having trouble completing your patient forms?’
Listen carefully to the answers. As we continue to recognize the complex and unique challenges injured workers face, we can provide empathetic, creative, and effective approaches that support their behavioral health, physical function, and overall well-being.”
The ultimate goal is not simply symptom relief but restoring function and quality of life. Recovery becomes meaningful when a worker can return to the activities that matter most, from driving and exercising to spending time with family and returning to productive work.
Len’s Outlook for the Future
At 10 months, Len has made steady progress and is almost fully recovered. He is looking forward to getting back to work.
Through coordinated medical care, ongoing management of his chronic health conditions, and behavioral health support that addresses the emotional challenges accompanying his injury, Len has regained strength, improved function, and feels much more confident about a full recovery.
Len realizes that without the compassionate support he has received from his physician, nurse case manager, employer, and claims professional, he might be in a very different place today. While his recovery journey is not over, he is moving forward with renewed confidence and hope.
Len’s experience is a reminder that behind every claim is a person whose recovery is shaped by far more than a diagnosis. When employers, clinicians, and claims teams work together to address physical, emotional, and social challenges, they can help injured workers like Len reclaim not only their health, but also their independence, purpose, and quality of life.
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