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.”

Derrick Amato

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:

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:

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:

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:

Reasons to consider utilization include:

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.