Lynch: Workers' Compensation Psychosocial Issues: A Big, Fat, Costly Problem

Thursday, February 2, 2017 | 0

Workers’ compensation claims adjusters are busier than the Ed Sullivan Plate Spinner.

Running around with one or two hundred lost time claims would make anyone dizzy, but at the recent National Workers’ Compensation & Disability Conference (NWCDC) in New Orleans, presenters tossed the frazzled spinners a few more plates to shoot up on the sticks.

The issue? Psychosocial factors delaying claim resolution.

At one well-attended session, Marco Iglesias, Medical Director for The Hartford, and Robert Hall, Corporate Medical Director for Optum, went into great detail about how psychosocial factors rear their heads in the claim process, and how they impede recovery.

For example, consider these research statistics based on a study of 75,000 claims:

• Time out of work increases 30% for a musculoskeletal claim with one co-morbid complication.
• Duration increases 57% if the claim co-morbidity is depression.
• According to The Hartford’s Dr. Iglesias, 10% of claims, the ones with all those psychosocial issues, cause 60% of claim costs.
• At another presentation, attendees learned that mental health, addiction and obesity are the three comorbidities causing the greatest cost and time away from work.
• Also, according to an Aetna presentation, 97% of depressed patients have a second co-morbid condition.

Research aplenty. Solutions, not so many.

So, perhaps it’s time for a more comprehensive discussion.

To begin that, let me propose a thesis:

Our nation’s current system for treating injured workers with mental health issues is uncoordinated, overly fragmented, highly wasteful and does not focus enough on speedy return to work. There is a critical need for a more systemic approach as well as an integrated coterie of clinicians and practitioners, trained in workers’ compensation, whose goals are to provide compassionate treatment with a steady return-to-work trajectory. 

The issue is compounded by the way claim adjusters, supervisors, nurses and defense attorneys view psychological issues. No one wants to "buy a psych claim," and many  believe that referring a claimant for behavioral health treatment does nothing more than create a lifetime annuity for a psychologist. Time and again this view has been proven correct.

What to do about that? Ay, there’s the rub. For in that question lies a host of difficulties. These, for instance:

• Most mental health professionals do not understand workers’ compensation. They do not realize either its statutory requirements or the concept of maximum medical improvement. They have spent many years being trained to treat the entire person. The players are the patient and the therapist, and it is like sitting on a two-legged stool. They do not fathom that, in workers’ compensation, the stool has five legs, with the other three occupied by the employer, the treating physician and the claim adjuster.
• Too often, by the time an adjuster or nurse recognizes that psychosocial issues may be impeding recovery and return to work, the claim may have gotten a little long in the tooth; it could be months old, or more.
• It can take a claim adjuster weeks — in rare cases, months — to find a psychologist and schedule an appointment. It can also take weeks or months for a report to make it back to the file. Moreover, finding a clinician with even a smattering of workers’ compensation knowledge or experience is often problematic.
• Because there is no mental health electronic health record system for workers’ compensation, every report is its own island — sometimes good, sometimes bad.
• Everything is paper-based, which wastes claim adjuster time and increases expense.
• Although psychologists understand the value of work as therapy, many see no reason to help coordinate early return to work with employers, claim adjusters or medical providers.

These are deep and difficult considerations. Later, we’ll describe one possible solution offered by a company in New Jersey, which, in the interests of full disclosure, is a Lynch Ryan client.

Tom Lynch is a principal with Lynch Ryan & Associates, a Massachusetts-based employer consulting firm. This column was reprinted with his permission from his Workers' Comp Insider blog.