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More than a dozen states have laws that make mental injuries compensable under certain conditions, and the workers compensation industry is responding with early intervention and treatment.
Mental claims are “not one-size-fits-all … but overall early intervention is always going to be best,” said Mark Debus, Chicago-based behavioral health team lead at Sedgwick Claims Management Services Inc.
From a store clerk who is robbed to a police officer who witnesses a mass shooting, the examples of events that can lead to comp claims run the gamut, as do the mental injuries: from anxiety and depression about return to work to post-traumatic stress disorder.
The industry is becoming more proactive in managing such claims although challenges exist, according to experts.
“For other (physical) injuries you have guidelines, check in the boxes, best practices,” said Beth Burry-Jackson, Richmond, Virginia-based senior vice president of case management and clinically integrated programs for Sedgwick. With mental health issues the treatment protocols are much less clear, and the success of mental treatment is not universal, which adds uncertainty and complexity to treating psych claims, she said.
Yet getting workers help immediately, rather than waiting — especially when there is a clear incident that led to mental injury — has emerged as a best practice, Ms. Burry-Jackson said.
“We know if we manage these proactively, (where) we can get better and more focused treatment on the compensable condition, we can make this person as whole as possible,” she said. “We do that with physical injuries, and we want to do that with mental injuries, as well.”
Using specialty providers also helps, said Tammy Bradly, Birmingham, Alabama-based vice president of clinical product development for Coventry Workers Comp. “You want someone who specializes in PTSD. … And you want to make sure that there’s experience in working with injured employees,” she said, adding that the distinction can help with recovery and return to work.
“It’s not a given that every time someone has PTSD that this will affect them the rest of their life,” said Mariellen Blue, Wayne, Pennsylvania-based national director of case management services at Genex | Coventry, part of Mitchell International Inc. “The better the treatment from the point of injury the better the chance of a positive outcome.”
Some claims may stay open for maintenance, similar to physical injury claims, and may require periodic follow-up visits, Ms. Bradly said. “That happens; there is no clear cut-and-dry sometimes,” she said.
Mental health treatment, once avoided in workers compensation claims that did not involve a compensable psychological injury, is now on the table in the claims management arena as employers and insurers increasingly accept that many physical injuries often include a mental component.