Workers’ Compensation and Mental Health Claims: What You Should Know

Denise GillinNews, Risk Management, Third Party Claim Administration

By Jill Root, Assistant Vice President and Third-Party Administration Claims Manager

Headlines in business and insurance magazines across the Commonwealth raise similar red flags for human resource and workers’ compensation professionals – prepare for a surge in mental health claims related to COVID. Stress of the coronavirus pandemic may lead to an increase in mental health-related workers’ compensation claims, especially among first responders and healthcare workers.

Are there other equally important stressors that deserve our attention? How is the workers’ compensation system prepared to respond, and what can we do to help?

As a Third-Party Administrator working closely with retirement communities and municipalities in Central Pennsylvania, we see the pressure placed upon our clients every day to take care of their residents and respond to emergencies while protecting their own health. Stress is not limited to them. Grocery workers and others in public-facing positions are forced to balance job performance and protecting those who remain at home.

All of these situations have contributed to a small rise in claims related to COVID, along with a slight spike following the protests that occurred in our area in May. Fortunately, the employers of these workers responded immediately, offering services through their human resource and Employee Assistance Program (EAP), both vitally important in getting employees the support they needed.

Managing mental health-related claims as workers’ compensation claims is complicated by a system built to respond to a physical injury: treat the injury; help the injured worker get back to pre-injury condition; and return to their role as a valued employee. There is usually a finite period of indemnity and a predictable outcome. In order for a mental health claim to be accepted, however, it must first be abundantly clear that an abnormal working condition exists. For first responders, the initial challenge is to determine what constitutes an “abnormal” condition. When it is clear an abnormal condition exists, the claim is picked up, and behavioral health treatment is payable under the claim.

The next challenge is reaching a treatment end point, determining when treatment is no longer reasonable, necessary, or related to the original incident. Treatment for a mental health issue is very subjective and can overlap and be triggered, again, by other personal or unrelated issues. Given the private nature of treatment, obtaining medical records is very hard. Finding an independent doctor to analyze or evaluate an individual, as it relates to a workers’ compensation claim, is also hard to do. As a result, many of these claims end up in litigation – a place no one wants to be.

What can and should we do?

  • Stay close to your employees, offer them assistance through your EAP or in other ways when they are exhibiting signs of undue stress. These programs can teach them how to manage stress and cope with the related anxiety.
  • Consider offering stress breaks like yoga or exercise programs – time for your employees to clear their heads. Employers who help their employees manage their social, mental, and physical health will have a more stable workforce and a positive, productive environment.
  • Communicate with your workers’ compensation carrier and employment law attorney. Use the policies available to you, and remember workers’ compensation, disability, and health insurance all work together to quickly provide your employees the help they need.

Stress builds – don’t be alarmed if related claims, for a wide variety of reasons, increase as well. Respond with care and consideration and lean on us to help with your stress.

Contact the Murray Risk Management Team or your Murray Risk Control Consultant at 717.397.9600 for more information – including mental health, introductory yoga, and other wellness resources contained in the Succeed / KPA risk management platform.

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