• Menu
  • Skip to main content
  • Skip to secondary navigation
  • Skip to primary sidebar
  • Skip to footer

Before Header

  • About
  • Contact
  • Privacy
 
Paradigm

Amaxx Workers Comp Blog

Reduce Workers Compensation Costs By 20-50%

Header Right

  • Home
    • Training Center
  • Search
    • Free Resources & Solutions
    • Subscribe to Free Newsletter
    • Create Free Training Center Account
    • Enroll in On-Demand Courses
    • Activate WC Mastery Membership
    • Request Strategic Coaching Session
    • Buy WC Guidebooks
  • Membership
    • Insider (free account)
    • WC Mastery
    • Teams & Managers Mastery
    • Training Partners
  • Products
    • On-Demand Courses
    • Specialty Courses
    • Certifications & Mastery Courses
    • Ultimate Guidebooks
    • Coaching
  • Blog
    • Video Blogs
    • COVID-19 / Coronavirus Pandemic
  • Login

Mobile Menu

  • Home
    • Training Center
  • Search
    • Free Resources & Solutions
    • Subscribe to Free Newsletter
    • Create Free Training Center Account
    • Enroll in On-Demand Courses
    • Activate WC Mastery Membership
    • Request Strategic Coaching Session
    • Buy WC Guidebooks
  • Membership
    • Insider (free account)
    • WC Mastery
    • Teams & Managers Mastery
    • Training Partners
  • Products
    • On-Demand Courses
    • Specialty Courses
    • Certifications & Mastery Courses
    • Ultimate Guidebooks
    • Coaching
  • Blog
    • Video Blogs
    • COVID-19 / Coronavirus Pandemic
  • Login
  • About
  • Contact
  • Privacy
You are here: Home / Claim Management / Effective Claim Handling for PTSD Claims

Effective Claim Handling for PTSD Claims

February 28, 2023 By //  by Senior Editor

Trends in workers’ compensation statutes allow for an employee to claim benefits for a diagnosis of Post-Traumatic Stress Disorder (PTSD). It is crucial to handle these claims with care, compassion, and a sense of urgency to defend them properly. The goal of every claim team should be to accept those claims with merit and pay all benefits the employee is entitled to, subject to defenses. Now is the time to review and defend these claims to reach better results and reduce program costs.

What is PTSD?

It is required to understand what PTSD is when being an effective claim handler. Failure to understand its origins, issues concerning compensability, and proper management will result in excessive costs.

Click Link to Access Free PDF Download

“9-Element Blueprint To Create Your Workers’ Comp Employee Brochure”


Given the complexity of PTSD, it is often left to statute to define when it is compensable and what requirements must be met. There are also questions of statutory presumptions often in place for police officers, firefighters, and emergency medical personnel. Never forget that these presumptions are rebuttable.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is typically the starting point for any PTSD diagnosis. This generally requires the employee to show the following:

  • Exposure to actual or threatened death, serious injury, or sexual violence;
  • Presence of intrusion symptoms associated with the traumatic event(s);
  • Persistent avoidance of stimuli associated with the traumatic event(s);
  • Negative alterations in cognitions and mood associated with the traumatic event(s);
  • Marked alterations in arousal and reactivity associated with the traumatic event(s);
  • Duration of the disturbances for more than one (1) month;
  • Disturbances that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; and
  • Disturbances that are not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

More and more states that allow for PTSD claims to be compensable require the diagnosis to be made by a licensed psychologist and/or psychiatrist.

Areas of Investigation for PTSD Claims

PTSD claims, even if they are admitted, require extensive and complete investigations. This is a condition that typically will not manifest until some time after the occurrence of the work injury. Timely follow-up and reporting on the employer’s part can assist in the investigation.

The basic level of claim investigation includes:

  • Recorded statement of the employee;
  • Interview and statements of injury witnesses and co-workers;
  • Request and obtain a complete set of medical records. This must include requesting all records related to counseling, mental health care, and substance abuse medical care and treatment.

Obtaining information on the employee’s socio-economic, family history, and education is also essential. Additional areas of background investigation should include:

  • ISO Claims search;
  • Unemployment and proper workers’ compensation records;
  • History regarding other litigation, including instances where the employee was a witness;
  • Police reports;
  • Court records;
  • Credit history and bankruptcy research;
  • Child support obligations; and
  • Internet/social media research.

It may also include the use of surveillance of the employee if they remain off work.

FREE DOWNLOAD: “9-Element Blueprint To Create Your Workers’ Comp Employee Brochure”

Use of Multiple Independent Medical Examinations

Defending claims regarding PTSD often requires the use of multiple independent medical examinations. These examinations must address physical trauma and mental health-related issues. Having two or more examinations presents several challenges for which the claim team and defense interests should prepare. These include:

  • Timing of the examinations and ensuring all information has been received under permissible discovery;
  • Anticipating issues related to objections to discovery requests and the need for pre-hearing limitation and motion practice; and
  • Proper timing of surveillance on the injured employee.

Be sensitive to the underlying conditions of the employee – use the velvet glove and not the iron fist. The employee might often need to explain embarrassing situations during a recorded statement or deposition. Work with defense counsel on how to best address these situations if the employee. This is especially required if an attorney does not represent the employee.\

Conclusions

Claims of PTSD can present several challenges for the claim management team and other interested stakeholders. When these claims arise, understanding the legal requirements of establishing the condition as a compensable work injury is crucial. Other steps must include a proactive investigation that goes above and beyond most claims and is conducted compassionately. It also requires multiple independent medical examinations that must be timed correctly. Now is the time to prepare and ensure the claim team is ready to deal with PTSD claims effectively.

 

Michael Stack, CEO of Amaxx LLC, is an expert workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employer and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

©2023 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

FREE DOWNLOAD: “9-Element Blueprint To Create Your Workers’ Comp Employee Brochure”

Filed Under: Claim Management

Related Articles

WC Cost Containment For The Claims Management Team

WC Cost Containment For The Claims Management Team

Dealing with Long COVID in Work Comp

Dealing with Long COVID in Work Comp

Expecting the Unexpected in Work Comp – Part 2

Expecting the Unexpected in Work Comp – Part 2

Expecting the Unexpected in Work Comp

Expecting the Unexpected in Work Comp

Subrogation Equals Lost Gold In Workers Compensation

Subrogation Equals Lost Gold In Workers Compensation

Employers: Avoid These Mistakes that Cost Your Work Comp Program Money

Employers: Avoid These Mistakes that Cost Your Work Comp Program Money
workers' comp Investigation

Special Investigation Unit: Stop Fraud with Proper Training

Special Investigation Unit: Stop Fraud with Proper Training
11 Ways to Manage Employer, Provider, and Employee Fraud in Workers’ Compensation

Snuff Out Fraud to Reduce Work Comp Costs

Snuff Out Fraud to Reduce Work Comp Costs

Identify Employer Contacts to Provide Adjusters Work Comp Claim Information

Identify Employer Contacts to Provide Adjusters Work Comp Claim Information

15 Point Checklist For Your Account Service Instructions

15 Point Checklist For Your Account Service Instructions

Internal Auditing Is Not Just For The Self Insured

Internal Auditing Is Not Just For The Self Insured

3 Things To Watch For In Workers Comp Surveillance Footage

3 Things To Watch For In Workers Comp Surveillance Footage

Free Download

How Do I Get My Adjusters To Follow My Account Handling Instructions? - FREE Download Click Here Now!

Train to Succeed

BECOME CERTIFIED IN WORKERS’ COMPENSATION

Proven Course Catalog & WC Toolbox Give You The Power To Achieve Lower Costs and Better Injured Worker Outcomes

VISIT WORKERS' COMP TRAINING CENTER

Previous Post: « Section 111 Civil Monetary Penalty Rulemaking is Delayed
Next Post: Unnecessary IMEs Cost Your Program Money »

Primary Sidebar

FREE DOWNLOAD

How Do I Get My Adjusters To Follow My Account Handling Instructions? - FREE Download Click Here Now!

Our Sponsors

ARCADIA - Enhancing Settlement Outcomes

The Structured Settlements Company
 

Catastrophic and Risk Solutions, Case Management Solutions, and Specialty Networks
 

MSAs, Section 111 Audits, & Conditional Payment Resolutions
 

Post-Settlement Administration
 

Medcor

Injury Triage, Onsite Clinics

Read Our Award-Winning Blog

Blog Categories

Search Our Archive

Subscribe to Our FREE Newsletter

Return-to-Work Essentials

Footer

Search Our Archive

Search our continually growing archive of over 2500 articles about Workers' Comp issues.

Quiclinks

  • Calculators
  • Terms & Abbreviations
  • Glossary of WC Premium Terms
  • WC Resources
  • Best Practices
  • Industries
  • Return-to-Work Essentials

RSS Recent Blog Posts

  • WC Cost Containment For The Claims Management Team
  • Dealing with Long COVID in Work Comp
  • Common Mistakes: Medical Care and Accepting Every Claim – Article 3 of 3
SUBSCRIBE TO OUR FEE NEWSLETTER
Let Us Help You Stomp Down the High Cost of Workers' Comp!
Top of Page ↑
  • Home
  • Training Center
  • Search
  • Membership
  • Products
  • Blog
  • About
  • Contact
  • Subscribe
  • Login
Copyright © 2023 Amaxx, LLC. All Rights Reserved. · Privacy Policy / Legal Notice