Viewpoint: The Impact of Behavioral Health on Workers’ Comp

Workers’ compensation is a crucial safety net for employees who suffer injuries or illnesses in the workplace by providing financial support, rehabilitation and medical care. However, beyond the physical aspects of workplace injuries, the role of behavioral health in workers’ comp is slowly gaining recognition.

Issues such as stress, anxiety, depression, and post-traumatic stress disorder (PTSD) can significantly affect an injured worker’s recovery and return-to-work outcomes.

Allow me to further explain this intersection of behavioral health and workers’ comp, drawing insights from research conducted by organizations like the National Council on Compensation Insurance (NCCI), the Workers Compensation Research Institute (WCRI) and Medrisks’ Industry Outlook findings.

The acceptance of engaging behavioral health in helping solve the bio-psychosocial aspects of a workplace injury at the claims desk level has yielded mixed results.

As someone who began his career as a claim’s professional several decades ago, one of the tenant expectations of adjusters managing work related disability claims is mitigation of what is commonly known as “injury creep.”

This is a phenomenon in which the severity or extent of an injury expands over time, potentially leading to increased costs and prolonged disability periods. The term is commonly used to describe situations where an initially minor injury evolves into a more complex and costly condition, often due to numerous factors, such as delayed recovery, secondary complications, or psychological aspects.

While we have socialized the concept of how such services play a role in recovery for as long as I can recall; it’s only been in the last few years that the topic has gotten positive traction amongst a smaller group of enlightened payers. Industry-wide, however, there remains many sceptics and the fear of utilization predominates still.

Claim situations that see implications for such strategies are defined by three unique pathways of need: a physical only injury with underlying biopsychosocial barrier present; a physical/mental claim (in which a distinct physical injury has occurred with stress related, such as an emergency room RN who gets physically assaulted by a patient and is dealing with the mental fallout from being emotionally threatened); a pure mental claim, in which the presumption of work related stress is accepted and under consideration.

The elephant is a reluctance to utilize behavioral health interventions (BHI’s) for fear of morphing the nature and scope of the injury beyond a physical to a mental one. For the stake of this conversation, the focus will be on those claims that are physical only yet present with markers or screen to be at mid- to high-risk due to an underlying predisposition or show signs of delayed recovery despite making physical gains.

Claims professionals, who are responsible for managing workers’ comp claims, often have several concerns regarding the utilization of behavioral health services in the context of claim management. While recognizing the importance of addressing mental health issues in the workplace, these professionals also grapple with various challenges and considerations when incorporating behavioral health services into their practices.

Other concerns or influencing factors might include:

• Claims professionals being ill-equipped or inexperienced in handling such cases compared to physical injuries, which tend to be more straightforward to assess and manage. Behavioral health interventions often involve addressing complex mental health issues such as fear of reinjury, depression from being away from work and colleagues, anxiety stemming from the economics of being out of work, PTSD and other psychological conditions. They are often concerned that engaging behavioral health treatment could be creating a secondary diagnosis that includes a psychological one.
• Despite industry buzz about the need and viability for such care, there is still a stigma attached to mental health issues. Adjusters may be hesitant to delve into mental health concerns due to fear of injury creep backlash. They may not have received adequate training or have access to appropriate resources for handling behavioral health issues in the context of rehabilitation of the whole person. This can also include a lack of insight about effectiveness of behavioral health interventions, or further compounded by limited access to mental health professionals who truly understand workers’ comp injury treatment needs.
• Some are operating under the belief that behavioral health interventions, such as Cognitive Behavorial Therapies (CBT) or short-term counseling, can add cost and is going to extend the duration of a claim. In the world of claims management. There is always pressure to keep unnecessary claim costs down and this expectation may prioritize more “traditional” medical treatments over biopsychosocial interventions to minimize expenses and/or avoid inflating the nature of the injury for which benefits are being paid.
• Unlike physical injuries that often have clear diagnostic criteria and measurable outcomes, the behavioral health aspect of claims can be perceived to be more subjective and challenging to evaluate. Adjusters may struggle with determining the severity and legitimacy of mental health issues, leading to uncertainty in how and when to manage these claims effectively. Conversely, there maybe apprehension as to how to successfully introduce such services to the injured employee. This conversation is one that must frame expectations focused on the work aspect of recovery and care and not lead the parties to a perception of an open door of care that can get murky if not articulated contextually.
• There may be legal and regulatory considerations that complicate the handling of behavorial health treatment in the workers’ comp system. Adjusters may be cautious about navigating these complexities while ensuring compliance with relevant laws and regulations.
• Some may question the return on investment of engaging behavioral health interventions. They may doubt the effectiveness of such interventions in facilitating claim resolution or improving return-to-work outcomes.

So, what do the experts say?

NCCI Research Findings

The NCCI has conducted extensive research on this topic. According to their findings, mental health conditions often prolong the duration of workers’ comp claims and increase overall claim costs. Employees with comorbid mental health conditions and physical injuries tend to have more complex recovery paths, leading to higher medical expenses and longer periods of disability. Moreover, NCCI research suggests that early intervention and access to mental health treatment can positively influence claim outcomes, including faster return-to-work rates and reduced disability durations.

WCRI Insights

Similarly, the WCRI has examined the impact of behavioral health on workers’ comp outcomes. Their research highlights the importance of addressing psychosocial factors in injury management and return-to-work strategies. WCRI studies have shown that injured workers with psychological comorbidities often face greater challenges in navigating the workers’ compn system and may experience delays in accessing appropriate treatment. Furthermore, WCRI research underscores the significance of workplace interventions, such as employee assistance programs and supportive work environments, in promoting mental health and facilitating successful claim resolutions.

MedRisk’s 2024 Industry Outlook found:

• 50% or more of injured employees experience clinically related depressive symptoms at some point post injury, especially during the first month after the injury.
• A 25% increase in the prevalence of anxiety and depression worldwide because of COVID-19 pandemic Injured employees reporting anxiety and depression.
• A 7% higher utilization than those who did not report these conditions.

Implications for Stakeholders

Employers, insurers, healthcare providers, and policymakers play pivotal roles in addressing behavioral health within the workers’ comp framework. Employers can promote mental wellness through supportive workplace policies, stress management programs and early intervention initiatives. Insurers can collaborate with healthcare providers to ensure timely and appropriate access to mental health services and incorporate behavioral health considerations into claims management practices. Healthcare providers, in turn, should adopt a comprehensive approach to treating injured workers, addressing both physical and psychological aspects of their recovery.

Policy recommendations based on NCCI and WCRI research include:

• Integration of mental health screenings into workers’ comp assessments.
• Expansion of access to mental health services for injured workers.
• Implementation of evidence-based interventions to address psychosocial barriers to recovery.
• Training programs for stakeholders to recognize and address behavioral health issues in the workplace.

Legislation Expanding Workers’ Comp Scope

More than a dozen new and revived bills have been filed since December 2023. Some call for new presumptions or add types of workers that would qualify, some deal with diagnoses and treatments for mental injuries, and some offer new parameters for qualifying for benefits.

Examples include:

• Colorado is considering a bill that would provide benefits for all workers who are repeatedly exposed to trauma.
• Arizona and Virginia lawmakers have introduced bills that would expand presumptions to include emergency dispatchers.
• West Virginia lawmakers are considering a bill that would expand which professionals can diagnose a first responder with post-traumatic stress disorder.
• Kentucky lawmakers are considering amendments that would make off-duty work compensable for PTSD.

Reasons to consider utilization include:

• Improving Outcomes: Addressing behavioral health issues can lead to improved overall outcomes for the claimant, including faster recovery, reduced disability, and ideally a quicker return to work.
• Reducing Costs: While there may be upfront costs associated with behavioral health interventions, addressing mental health issues early in the claims process can potentially prevent the escalation of problems and reduce long-term costs associated with prolonged disability or litigation.
• Enhancing Employee Resiliency: Taking a proactive approach to addressing biopsychosocial health issues can improve employee’s ability to push through the fear, apprehension of re-injury, job satisfaction and employer loyalty, leading to a more positive work environment overall. The worker’s perception of their disability and its impact on their ability to work can significantly influence their motivation and willingness to return to work. Financial concerns, including loss of income and uncertainty about future earnings, can affect the worker’s motivation to return to work.

Behavioral wellbeing is a significant determinant of workers’ comp outcomes, influencing claim durations, costs and return-to-work success. Research conducted by organizations like NCCI and WCRI underscores the importance of addressing mental health within the workers’ comp system.

By implementing evidence-based strategies and policies, stakeholders can enhance support for injured workers, improve claim management practices, and promote overall workforce well-being. Prioritizing behavioral health in workers’ comp is not only ethically imperative but also economically beneficial, contributing to healthier workplaces and more sustainable claim resolutions. Improved resiliency for employee benefits all stakeholders.

The challenge is to get these concepts fully vetted and rightfully positioned as reliable tools in the adjuster’s toolbox. The industry messaging around this topic, supported by reliable and credible studies has set the stage to further enable this perspective.

Industry leaders need to take charge and move the needle from one of support to action at the desk level.

Artificial intelligence, claims analytical tools, and APPS exist to help define those at “risk” using these technology advances-but at the end of the day these tools are only as effective as the human making the decision to use or not to use.

Amato has more than 35 years of experience in the workers’ comp industry, including working for large national multi-lines carriers. He is currently vice president of sales & account management for Ascellus Behavioral Health.