Age Is Not the Diagnosis: Managing the Older Injured Worker in Workers’ Compensation 

The Case Manager

According to the National Council on Aging, economic insecurity is a pressing issue for older adults. More than 17 million Americans age 65 and older were economically insecure in 2024, living at or below 200% of the federal poverty level. For a single person in 2026, that amounts to $31,920 per year. Click here to read the e-letter 

Today, higher costs for housing, utilities, groceries, and healthcare, combined with inadequate or diminished retirement savings, are putting additional financial pressure on many older Americans. For some, remaining in or returning to the workforce has become an economic necessity. 

As a result, workers’ compensation nurse case managers can expect to work with older injured employees. These workers may come to a claim with arthritis, diabetes, cardiovascular disease, previous orthopedic injuries, degenerative changes, or other chronic conditions that can complicate recovery. 

As a result, workers’ compensation nurse case managers are increasingly working with older injured employees. These workers may come to a claim with arthritis, diabetes, cardiovascular disease, previous orthopedic injuries, degenerative changes, or other chronic conditions that can complicate recovery. 

However, we need to be careful not to assume that age alone predicts a poor outcome. Older workers may experience fewer workplace injuries than younger workers, but when injuries occur, recovery and periods of disability can sometimes be longer. There is also an important difference between age and health status. A healthy, active 65-year-old working full duty before an injury may recover more successfully than a younger worker with multiple poorly controlled health conditions. 

For the workers’ compensation nurse case manager, the key is to look at the whole person—not simply the date of birth. 

Establish the Pre-Injury Baseline 

One of the first questions should be: What was this employee able to do before the injury? 

An employee may have significant arthritis or degenerative changes on an X-ray or MRI yet have been working full duty without pain or limitations before a workplace accident. The existence of a preexisting condition does not automatically explain the worker’s current symptoms or disability. 

The nurse case manager should review the mechanism of injury, previous medical history, prior treatment involving the injured body part, diagnostic findings, and, most importantly, the employee’s pre-injury functional abilities. 

When a Workplace Injury Aggravates a Preexisting Condition 

This is where these cases can become complicated. A workplace injury may aggravate an underlying condition rather than cause an entirely new one. 

Although compensability standards vary by state and jurisdiction, clear medical documentation is critical. The nurse case manager can help ensure that the treating physician addresses questions such as: 

• What diagnosis is currently being treated? 

• What objective findings support the diagnosis? 

• Did the workplace event cause or aggravate a preexisting condition? 

• If aggravated, is the change temporary or permanent? 

• Are current restrictions related to the workplace injury, the underlying condition, or both? 

• Has the employee returned to their pre-injury baseline? 

The nurse case manager does not determine compensability. However, ensuring these questions are asked of the treating physicians and the answers documented clearly, the nurse case manager provides valuable clinical information to the adjuster and other professionals responsible for making that determination. 

Coordinate the Whole Patient 

Older injured workers may have several physicians and take multiple medications. Diabetes, cardiovascular disease, osteoporosis, balance problems, obesity, previous joint replacements, or other conditions can affect surgery, rehabilitation, pain management, and recovery. 

The nurse case manager can identify these potential barriers early, improve communication among providers, monitor progress, and begin realistic return-to-work planning, hopefully preventing avoidable complications and prolonged disability. 

Cost Control Should Not Mean Delayed Care 

Controlling costs is an important part of workers’ compensation, but delaying appropriate care can sometimes increase costs. Things like repeated authorization delays, postponed diagnostic testing, delayed specialist consultations, or prolonged debate over whether symptoms are related to a preexisting condition can interrupt care coordination and recovery. Delayed care can cause older injured workers to become deconditioned, lose strength and confidence, and remain out of work longer. 

Cost containment should not simply mean spending less. It should mean ensuring the right care is provided at the right time for the right reason. Early intervention with a nurse case manager may require an upfront expenditure but can potentially prevent complications, prolonged disability, unnecessary medical utilization, and a failed return to work. 

Age Should Not Become the Diagnosis 

Older workers bring experience, knowledge, and skills to the workplace. When they are injured, their care should be based on their individual health, functional status, injury, and recovery—not assumptions based on their age. 

Workers’ compensation nurse case managers are uniquely positioned to keep the focus where it belongs: understanding the worker’s pre-injury baseline, identifying how preexisting conditions affect recovery, ensuring clear medical documentation, preventing unnecessary delays, and coordinating a safe and realistic return to work. 

The goal is not simply less care. It is appropriate care that produces the best possible outcome. 

Thanks for reading. Would love to know your thoughts. Email me at anne@nursesadvocates.com  

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