Older Workers Show 21% Higher Medical Utilization, Driven by Comorbidities and Diagnoses, NCCI Finds
The share of lost-time workers compensation claims involving workers aged 65 and older has doubled over the past 13 years, rising from 4% in accident year 2012 to 8% in 2025, according to the National Council on Compensation Insurance (NCCI).
Claims from these older workers carry an average utilization level of 17,850 units, about 21% higher than the 14,735 level for workers aged 16 to 64, NCCI found. The analysis also found that claims for male workers require 28% more medical care on average than claims for female workers, a gap driven primarily by differences in industry mix and diagnosis types rather than gender itself.
NCCI said medical utilization reflects the overall intensity of medical services used rather than cost, isolating treatment-intensity differences that cost figures can obscure because costs reflect both quantity of services and their prices.
Diagnosed Conditions and Comorbidities Drive the Age Gap
Using an Oaxaca-Blinder decomposition across four variables — cause of injury, industry class, primary diagnosed medical condition and treated comorbidity — NCCI determined that diagnosed medical conditions account for 1,959 utilization units, or roughly 63% of the age-related gap. If older workers had the same distribution of diagnosed conditions as younger workers, the utilization gap would fall to 8% from 21%, the report said.
Rotator cuff tears and hip or pelvis fractures are more common among older workers and are associated with higher utilization, while low back pain and minor ankle or foot injuries are more common among younger workers and typically require less treatment, according to NCCI.
Treated comorbidities have an even larger association with the gap, NCCI found. If older workers had the same distribution of treated comorbidities as younger workers, the age-related utilization gap would shrink to just 4% from 21%.
The combined contribution of diagnosed conditions and comorbidities actually exceeds the observed 21% gap, meaning that after adjusting for both factors, the decomposition estimates older workers would have 9% lower utilization than younger workers. NCCI said this indicates that age alone is not a useful predictor of medical utilization once differences in diagnosed conditions and comorbidities are considered.
Industry mix moved in the opposite direction, the report said. Older workers are less likely to work in construction, an industry associated with more serious injuries, and more likely to work in health care, where average utilization is below the overall average. If older workers had the same industry distribution as younger workers, the gap would have widened to 24% from 21%, according to NCCI.
Cause of injury played a smaller role: older workers are twice as likely to slip and fall as younger workers, while younger workers are more prone to strains, cuts and burns, but these offsetting effects reduced the gap by only 352 units, to 19% from 21%, NCCI found.
Industry and Diagnosis Mix Explain Most of the Gender Gap
For the gender analysis, NCCI found male workers average 16,156 utilization units vs. 12,631 for female workers. Industry mix explains 1,147 of those units: 16% of injured male workers are in construction compared with 1% of injured female workers, while 21% of injured female workers are in health care compared with 2% of injured male workers. If men and women had the same industry mix, the gap would fall to 19% from 28%, according to the report.
Diagnosed medical conditions explain another 1,075 utilization units, or about 31% of the gap, NCCI said, with disc disorders and rotator cuff tears more common among men and neck pain and minor knee injuries more common among women. Comorbidities explain 454 units, or 13% of the gap, with men more likely treated for hypertension, substance abuse and diabetes, and women more likely treated for degenerative conditions and mental health issues.
Cause of injury contributed only 38 units, about 1% of the total gap. Combined, NCCI found that if male workers had the same industry mix, diagnoses, comorbidities and injury causes as female workers, the gender gap in medical utilization would fall from 28% to 7%.
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