Injured workers who have, or develop undiagnosed and untreated behavioral health issues are more likely to fall into the ‘creeping catastrophic’ claim pool; a simple meniscus tear that degenerates into months- or years-long claim with multiple treatments and medications — and exorbitant costs.
Identifying and treating these issues is tricky. The stigma attached to mental health issues prevents many people from seeking treatment; providers and claims handlers are often unfamiliar with signs and symptoms, and payers may be reluctant to pay for something they believe is unrelated to the actual injury. However, it behooves employers, and other payers to at least consider ways to target behavioral health issues among their injured workers.
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Behavioral Health Issues
Behavioral health issues — also called mental health or psychosocial — include a variety of diagnoses. Anxiety and depression are the ones more commonly seen among injured workers.
In addition to an extended duration of the claim, some signs that may indicate a psychosocial issue is present include:
- Pain develops due to non-medical issues.
- Function does not improve.
- Multiple providers are involved.
- Visits to the emergency room with drug-seeking behavior.
- Overutilization of treatments.
- Catastrophic thinking.
- Perceived injustice, toward the employer or others.
There are myriad reasons why some injured workers develop psychosocial issues, related to such things as adverse childhood experiences, environmental stimuli or genetics. The important thing is to identify them and intervene as early as possible.
Identification
Training and education are key to uncovering psychosocial issues. Most claims handlers, as well as medical providers and others, don’t have the backgrounds to detect psychosocial issues.
The injured worker, supervisors, and all others involved in the claim should also be trained to understand the realities of mental health issues. Soft skills, such as communication, conflict resolution, and identifying potential issues should be included.
Contact with all injured workers soon after the injury and on an ongoing basis is a best practice. During the conversations, certain screening questions can be asked that might trigger a red flag for potential issues:
- When do you think you will be going back to work?
- How are you doing?
- Have you talked to your employer?
- What does your treating physician say about your recovery and return to work?
Such questions can reveal the injured worker’s overall feelings toward his workplace. The answers might signal contention between the injured worker and his supervisor and/or colleagues.
The person’s sense of control or lack thereof over his work can also be an indicator of stress and, potentially, psychosocial issues. People who feel they have little or no control tend to experience more stress. The lack of a sense of belonging to the company and concerns about job security may also lead to psychosocial issues. The injured worker needs to know his job is safe and that you want him back on the job as soon as possible, even if that means doing light duty.
Interventions
There are formal programs to address injured workers with psychosocial issues. Companies looking to develop their own programs should consider the following:
Special Attention
Once an injured worker has been deemed a potential risk for psychosocial issues, the claim should be handled by those who have been trained and have an understanding of the challenges. Specialized claims adjusters, for example, should be assigned the claim. The injured worker should be given a detailed outline of the workers’ compensation process and understand what to expect and what is expected of him. He should be made to realize he does have control over his own
Team approach
The Claims adjuster, nurse case manager, treating physician, injured worker and anyone else should work together on the claim. The treating physician, for example, needs to be a part of the effort to avoid him undercutting the team’s efforts.
Clinical interventions with a work focus
The injured worker should have access to a mental health provider as soon as possible. If your company or insurer does not already have a psychologist in the network, working with a local provider should be considered. Community resources can be checked to see what is available.
Goal setting
Working together the team should establish timeframes for various aspects of the recovery, with the injured worker’s buy-in. The focus should be on the injured worker’s abilities, rather than his disability. The employer must be open to allowing the injured worker to return in a light- or modified-duty capacity.
Conclusion
Some state workers’ compensation laws allow coverage for mental injuries, while others do not. Regardless of the regulations in a particular jurisdiction, taking a proactive stance and, perhaps, spending some money at the beginning of a claim will generally be much more cost-effective than ignoring psychosocial issues.
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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.
