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The impact on mental health and well-being in workers’ comp

The impact on mental health and well-being in workers’ comp

According to the World Health Organization, mental health is described as: “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stress of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” But the World Health Organization’s definition applies only to part of the population.

At any given time, one-in-five American adults suffer from a mental health condition that impacts their daily lives. Stress, anxiety, and depression are among the most prevalent for injured workers. Left untreated they can render a seemingly straightforward claim nearly unmanageable, resulting in poor outcomes and exorbitant costs.

Increasingly, many in our industry are recognizing the need to proactively do all we can to address this critical issue. We must openly discuss and gain a deep understanding of a subject that until now has been taboo.

Four prominent workers’ compensation experts helped us advance the conversation on mental health in the workers’ comp system during a recent webinar. They were:

  • Bryon Bass, senior vice president for disability, absence, and compliance at Sedgwick
  • Denise Zoe Algire, director of managed care and disability for Albertsons Companies
  • Maggie Alvarez-Miller, director of business and product development at Aptus Risk Solutions
  • Brian Downs, vice president of quality and provider relations at the Workers’ Compensation Trust

Why it matters

Mental health conditions are the most expensive health challenges in the nation, behind cancer and heart disease. They are the leading cause of disabilities in high-income countries, accounting for one-third of new disability claims in western countries. These claims are growing by 10% annually.

In addition to the direct costs to employers are indirect expenses, such as lost productivity, absenteeism, and presenteeism. Combined with substance abuse, mental health disorders cost employers between $80 and $100 billion in these indirect costs.

In the workers’ comp system, mental health conditions have a significant impact on claim duration. As we heard from our speakers, these workers typically have poor coping skills and rely on treating physicians to help them find the pain generator, leading to overutilization of treatments and medications.

More than 50% of injured workers experience clinically-related depressive symptoms at some point, especially during the first month after the injury. In addition to the injured worker himself, family members are three times more likely to be hospitalized three months after the person’s injury. Many speculate that the distraction of a family member leads the injured worker to engage in unsafe behaviors.

Mental health problems can affect any employee at any time and the reasons they develop are varied. Genetics, adverse childhood experiences and environmental stimuli may be the cause.

The stress of having an occupational injury can be a trigger for anxiety or depression. These issues can develop unexpectedly and typically result in a creeping catastrophic claim.

One of our speakers relayed the story of a claim that seemed on track for an easy resolution, only to go off the rails a year after the injury. The injured worker, in this case, was a counselor who had lost an eye after being stabbed with a pen by a client. Despite his physical recovery, the injured worker began to struggle emotionally when he finally realized that for the rest of his life he would be blind in one eye. Because his mental health concerns were raised one year after the injury, there were some questions about whether he might be trying to game the system.

Such stories are more commonplace than many realize. They point out the importance of staying in constant contact with the injured worker to detect risk factors for mental health challenges.


Mental health conditions — also called biopsychosocial or behavioral health — often surprise the person himself. Depression can develop over time and the person is not clued in until he finds himself struggling. As one speaker explained, the once clear and distinct lines of coping, confidence, and perspective start to become blurred.

In a workers’ comp claim, it can become the 800-pound elephant in the room that nobody wants to touch, talk about or address. Organizations willing to look at and address these issues can see quicker recoveries. But there are several obstacles to be overcome.

Stigma and social prejudice are one of the biggest challenges. People who do realize they have a problem are often hesitant to come forward, fearing negative reactions from their co-workers and others.

Depictions of people suffering from behavioral health issues in mass media are often negative but are believed by the general public. Many people incorrectly think mental health conditions render a person incompetent and dangerous; that all such conditions are alike and severe; and that treatment causes more harm than good.

As we learned in the webinar, treatment does work and many people with mental health conditions do recover and lead healthy, productive lives. Avoiding the use of negative words or actions can help erase the stigma.

Cultural differences also affect the ability to identify and address mental health challenges. The perception of pain varies among cultures, for example. In the Hispanic community, the culture mandates being stoic and often avoiding medications that could help.

Perceptions of medical providers or employers as authority figures can be a deterrent to recovery. Family dynamics can play a role, as some cultures rely on all family members to participate when an injured worker is recovering. Claims professionals and nurses need the training to understand the cultural issues that may be at play in a claim, so they do not miss the opportunity to help the injured worker.

Another hurdle to addressing psychosocial issues in the workers’ comp system is the focus on compliance, regulations and legal management. We are concerned about timelines and documentation, sometimes to the extent that we don’t think about potential mental health challenges, even when there is clearly a non-medical problem.

Claims professionals are taught to get each claim to resolution as quickly and easily as possible. Medical providers — especially specialists — are accustomed to working from tests and images within their own worlds, not on feelings and emotional well-being. Mental health issues, when they are present, do not jump off the page. It takes understanding and processes, which have not been the norm in the industry.

Another challenge is the fact that the number of behavioral health specialists in the country is low, especially in the workers’ comp system. Projections suggest that the demand will exceed the supply of such providers in the next decade. Our speakers explained that with time and commitment, organizations can persuade these specialists to become involved.

Jurisdictions vary in terms of how or whether they allow mental health-related claims to be covered by workers’ comp. Some states allow for physical/mental claims, where the injury is said to cause a mental health condition — such as depression.

Less common are mental/physical claims, where a mental stimulus leads to an injury. An example is workplace stress related to a heart attack.

“Mental/mental claims” mean a mental stimulus causes a mental injury. Even among states that allow for these claims, there is wide variation. It typically hinges on whether an “unusual and extraordinary” incident occurred that resulted in a mental disability. A number of states have or are considering coverage for post-traumatic stress among first responders. The issue is controversial, as some argue that the nature of the job is itself unusual and extraordinary, and these workers should not be given benefits. Others say extreme situations, such as a school shooting, is unusual enough to warrant coverage.

What can employers do

Despite the challenges, there are actions employers and payers are successfully taking to identify and address psychosocial conditions.

For example, Albertsons has a pilot program to identify and intervene with injured workers at risk of mental health issues that are showing promise. The workers are told about a voluntary, confidential pain screening questionnaire. Those who score high (i.e. are more at risk for delayed recoveries) are asked to participate in a cognitive behavioral health coaching program.

A team approach is used, with the claims examiner, nurse, treating physician and treating psychologist involved. The focus is on recovery and skill acquisition. A letter and packet of information are given to the treating physician by a nurse who educates them about the program. The physician is then asked to refer the injured worker to the program, to reduce suspicion and demonstrate the physician’s support.

Training and educating claims professionals is a tactic some organizations are taking to better address psychosocial issues among injured workers. The Connecticut-based Workers’ Compensation Trust also holds educational sessions for its staff with nationally known experts as speakers. Articles and newsletters are sent to members to solicit their help in identifying at-risk injured workers.

Ongoing communicating with the injured worker is vital. Asking how they are doing, whether they have spoken to their employer when they see themselves returning to work are among the questions that can reveal underlying psychosocial issues. Nurse case managers can also be a great source of information and intervention with at-risk injured workers.

Changing the workplace culture is something many employers and other organizations can do. Our environments highly influence our mental health. With the increased stress to be more productive and do more with less, it is important for employers to make their workplaces as stress-free as possible.

Providing the resources to allow employees to do their jobs and feel valued within the organization helps create a sense of control, empowerment, and belonging. Helping workers balance their workloads and lives also creates a more supportive environment, as does provide a safe and appealing workspace. And being willing to openly discuss and provide support for those with mental health conditions can ensure workers get the treatment they need as soon as possible.

As one speaker said, “By offering support from the employer, we can reduce the duration and severity of mental health issues and enhance recovery. Realize employees with good mental health will perform better.”

Source: PropertyCasualty360
Photo: Shutterstock

Intersection of workers comp and federal laws difficult to manage

Intersection of workers comp and federal laws difficult to manage


Following the presidential election workers compensation legal experts say they are in wait-and-see mode with regard to the recent uptick in U.S. Equal Employment Opportunity Commission complaints.

“Everything with the EEOC may be off because of the election results this week,” said Chicago-based Jeff Nowak, co-chair of the labor and employment practice group with Franczek Radelet P.C., in a webinar hosted Thursday by the Disability Management Employer Coalition on Thursday.

The webinar focused specifically on how workers comp intersects with the Americans with Disabilities Act Amendments Act and the Family and Medical Leave Act, and provided tips on how to avoid penalties, fines and lawsuits.

Mr. Nowak, who said he is watching whether the EEOC will be the priority for Donald Trump’s administration that it has been for other administrations, said a number of pending complaints and rulings are highlighting the difficulty for employers who want to both comply with federal laws and get injured employees back to work.

Adopted in 2008, the ADAAA amended the ADA, which essentially bars employers from discriminating against people with disabilities in any aspect of employment-related activities. Under the FMLA, employers are required to give their employees up to 12 weeks of unpaid leave per year for specific reasons, including a serious health condition or to care for an immediate family member who has a serious health condition. According to experts, the two can intersect with workers comp and create EEOC complaints.

Panelists highlighted communication with employees as a better way to smooth the path to avoids costly litigation.

Dubbed the “interactive process” in worker comp, this communication requirement calls for each side of a claim to exchange of information in good faith. It is key to implementing ADAAA and FMLA requirements and state regulations that govern workers comp, experts say.

Communication is “the most critical element,” said Adrienne Paler, director of total health and productivity management, integrated disability and absence management for Sutter Health, a Sacramento, California-based health system. “We need to tailor it … what is the employee asking for? That’s a question to ask the employee.”

“The risk of litigation increases when an employer is ignorant about their obligations under ADAAA to engage in the interactive process … they are unwilling to think creatively what they can do to that job, what changes can they make to help the employee perform the job,” said Mr. Nowak.

Source: BusinessInsurance

Rule Changes & Notices

Rule Changes & Notices


69L-7.501: The proposed rule is amended to adopt the 2016 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals (“Manual”), as approved by the Three-Member Panel during a scheduled meeting held on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The 2016 Edition of the Manual increases the per diem reimbursement rates for surgical and non-surgical hospital inpatient services and the threshold dollar amount triggering Stop-Loss reimbursement above reimbursement allowances specified in the 2014 Edition of the Manual, as adopted by the existing rule. The 2016 Edition of the Manual also provides an updated fee schedule for various categories of hospital outpatient services based on the Current Procedural Terminology (“CPT”) line level charge data, with an adjustment of the Maximum Reimbursement Allowance (“MRA”) based on the geographic location of the service provider.

69L-7.100: The proposed rule amendment incorporates and adopts for use the 2016 Edition of the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (“ASC Reimbursement Manual”), as approved by the Three-Member Panel on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The 2016 Edition of the ASC Reimbursement Manual contains an updated list of the Maximum Reimbursement Allowances (“MRAs”) for various medical services provided to Florida’s injured workers.

69L-7.020: The proposed rule amends the existing rule to adopt and incorporate by reference the 2016 Edition of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, as approved by the Three-Member panel on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The aforementioned manual is updated to incorporate the 2016 Medicare Conversion Factor and Resource Based Relative Value Scale (“RBRVS”) geographic-specific reimbursement levels used to determine Maximum Reimbursement Allowances (“MRAs”) for physician’s services and non-surgical hospital outpatient services provided to Florida’s injured workers.

A copy of the notice and link to the proposed Rules are below:

FL Workers’ Compensation Reimbursement Manual for Hospitals, 2016 Edition
FL Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs), 2016 Edition
FL Workers’ Compensation Health Care Provider Reimbursement Manual, 2016 Edition


Communication Can Help Reduce Workers’ Insurance Costs

Communication Can Help Reduce Workers’ Insurance Costs

Injuries, illnesses and other accidents at the workplace will happen, even with the best possible security measures in place. However, that doesn’t mean a company should ignore proper safety procedures, or skip steps to prevent these incidents from happening and finding ways to lower workers compensation insurance costs.Read More Here

Work Comp Case Law Update: Compensability

Work Comp Case Law Update: Compensability

In Dilallo v. Sch. Bd. of Broward Cnty./OptaComp, d/a 4/16/12, 13-16388, Judge Hogan held that an idiopathic fall on employer premises before reaching the elevator to her office to start work was compensable under the premises rule.  “[A]n injury is deemed to have occurred in the course and scope of employment if it is sustained by a worker, on the employer’s premises, while preparing to begin a day’s work or while doing other acts which are preparatory or incidental to performance of his or her duties, and which are reasonably necessary for such purpose.” Vigliotti v. K-Mart, 1st DCA.  JCC rejected E/C argument that Caputo and Walker required that claimant was actively engaged in work at the time of the idiopathic fall.