Much is currently being discussed and published about Post-Traumatic Stress Syndrome. (PTSD) Most of this discussion deals with military veterans who served in combat. However, PTSD can occur in civilian life events and in a workers compensation loss as well.
What is PTSD?
PTSD is a mental health condition brought on by a terrifying or horrific experience. Usually the situation must be life threatening. It is highly unlikely that a true PTSD will occur in the normally experienced traumatic injury. Therefore, when an employee claims PTSD as a result of on the job injury it should be viewed with skepticism.
As soon as the employee alleges any claim of a mental disorder, immediate investigation and medical examination must be done. It can be easy for an employee to develop a fraudulent claim. Mental illness is one area of health care that is still very subjective. It is hard to determine if symptoms are real or imaginary.
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“The 6-Step Process To Determine Workers’ Comp Injury Causation”
Worker Compensation Injuries that might Trigger PTSD:
A few Injuries that are capable of producing PTSD are:
- Injuries involving amputations.
- Severe degrees of paraplegia.
- Mass fellow employee injuries and/or, witnessed death due to a catastrophic incident.
- Survivor guilt.
- Long term medical treatment that fails to restore the employee to pre-injury function.
Symptoms:
There are four grouped types of symptoms. They are known as: Intrusive Memories, Negative Changes of Mood or Thinking, Avoidance, and Changes in Emotional Reaction. While each grouping has differentials, all make for personal behavioral changes.
Flashbacks, Bad Dreams, Negative Feelings about Self or Others, Lack of Self-Motivation, Loss of Energy, Poor Concentration, Strange Reactions to Emotions and Memory Issues are just a few of the outward symptoms to look for. In some instances suicide thoughts or attempts are evident.
Tests and Diagnosis:
Observance of behavior and psychological evaluation are the ways to diagnose PTSD. Add that the employee must have had or witnessed a horrific incident or catastrophe. All symptoms must meet the criteria set out in The American Psychiatric Association Publication (Diagnostic and Statistical Manual of Mental Disorders known as DSM-5).
Treatment & Drugs:
Antidepressants and Anti-Anxiety Medications are often used to in the treatment process.
Most of the treatment will be through several types of psych-therapy. These may include free association, cognitive pattern discussion, behavioral modification, and group therapy.
Most treatment is frequent, slow, and long. There may be the need of interface with others for coping mechanisms. Bottom line treatment is very costly.
PTSD treatment has potential for various functional capacity recoveries where hopefully a full recovery occurs. However, there can be any degree from full to no recovery. Monitor the file closely to keep exposure values under constant scrutiny. It is suggested in these instances that a nurse case manager be utilized.
Re-Insurer Reporting:
Due to the expense and length of medical treatment it is wise to report the loss to the re-insurer. The claim can always be withdrawn if retention value won’t be penetrated. However, being optimistic or delaying a report can cause coverage and recovery issues with the re-insurer. If the adjuster balks at reporting to the re-insurer, be firm in requiring it be reported.
Second Injury Development:
Determine if the employee has been previously treated for PTSD. Explore any underlying pathology that coupled with PTSD can increase disability. When either of these situations is evident, look for state second injury fund recovery or transference.
Keep Tabs On Claimant Activity:
PTSD may not impede physical mobility or activity. Physical activity might be encouraged by the medical provider to help the employee keep their mind off problems. Frequent visits by the adjuster, employer or nurse practitioner are to be encouraged.
They help the employee feel needed and can help in the coping aspects of recovery. The employee is more likely to strive for recovery.
Frequent visits may also uncover any employee irregularities.
Summary:
- Post-Traumatic Stress Syndrome can be brought into a worker’s compensation claim.
- Medical treatment is long and costly.
- Strong investigation and close monitoring is demanded.
- Look for recoveries from re-insurance, second injury funds, and possible subrogation from the cause of the horrific incident that brought on PTSD.
Author Michael B. Stack, Principal, COMPClub, Amaxx Work Comp Solutions. He is an expert in employer communication systems and helps employers reduce their worker’s comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool. He is co-author of the #1 selling book on cost containment, Your Ultimate Guide To Mastering Workers Comp Costs www.reduceyourworkerscomp.com, and Founder of the interactive Workers’ Comp Training platform COMPClub. Contact: mstack@reduceyourworkerscomp.com.
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.
