Effect of Diabetes Mellitus, Peripheral Neuropathy, or Charcot Arthropathy on Workers Compensation Claims

Abstract

Category: Diabetes Introduction/Purpose: Charcot neuroarthropathy is a complication of peripheral neuropathy commonly resulting from diabetes mellitus. The actual trigger for a Charcot neuroarthropathy episode is unknown. Due to the chronic nature and multifactorial causality of the disease, affected patients frequently have difficulty with workers’ compensation claims resulting in appeals or even outright denials. This study retrospectively reviewed patient’s charts with workers’ compensation claims in a foot and ankle practice to determine the incidence of diabetes mellitus, peripheral neuropathy, and Charcot neuroarthropathy. The study will then review each affected patient to determine if there is a correlation between his or her health status and claim status. Methods: From January 2011 to January of 2015, 331 patients were seen in a tertiary foot and ankle clinic with a worker’s compensation claim. A chart review identified patients with diabetes mellitus, peripheral neuropathy, or Charcot neuroarthropathy. The claims database was reviewed to determine the number of claim appeals submitted for each patient. Results: There were 43 patients (13% of workers compensation patients) with diabetes, 12 (4% of workers compensation patients) with peripheral neuropathy, and 3 (7% of diabetics, 1% of workers compensation patients) with Charcot. There were a total of 115 appeals in patients without Diabetes Mellitus, peripheral neuropathy, or Charcot arthropathy, 23 appeals in patient with Diabetes, 8 appeals in patients with peripheral neuropathy, and 6 appeals in the patients with Charcot. Conclusion: Diabetes alone did not increase the number of appeals. Patients with peripheral neuropathy, however, were two- times more likely to have an appeal than a patient without peripheral neuropathy. Patients with Charcot had eight times more appeals than patients without Charcot. Thus, Charcot arthropathy and peripheral neuropathy are strong indicators an increased claim appeals in the Worker’s Compensation system. This data only reflects appeals of claims for services provided and does not reflect difficulty with obtaining approvals for planned procedures.