Psychological Intervention in WC Claims

Below is a link to an interesting article that addresses, at a high level, perceptions and utilization of psych professionals in the workers' compensation process. The article is possibly a good STARTING point for the discussion of secondary psychological symptoms following a traumatic injury or occupational disease. And a discussion is needed, both at the state regulatory level and between insurers, self-insured organizations, medical case managers (nurses), vocational rehabilitation counselors, insurance brokers, employers and the claim professionals. With the ever decreasing ability of our society to address and treat a range of mental conditions and challenges, diagnosed and not, those who enter into the workers' compensation system are in many cases (unfortunately) met by a system that, as the article points out, biased against mental health involvement in the wc claim process.

The article refers to one challenge in the system, the lack of education and data / metrics / best practices for short term treatment of mental challenges following a workplace injury or disease. We have seen, as referred to in the article, far too many psychological treatment professionals that know very little to nothing about the workers' compensation system, and some unfortunately begin a course of lifetime maintenance care when they learn who the payer is. Another challenge is the lack of data / metrics / best practices for the claims professionals responsible for workers' compensation claims. Many claims people have seen system abuses, few have seen good, efficient, long lasting results from psychological intervention. It is no wonder that many of the experienced claims people are hesitant, if not resistant. What would help? More well educated treating providers about the needs, and limitations, of the workers' comp system AND better data and best practices to highlight successful utilization of psychological treatment professionals. Significantly increasing state and federal public funding of basic psychological treatment would go a long ways towards helping in this area.

One of the most challenging topics not mentioned in the article, from the perspective of the independent claims professional, is the outside pressure exerted by the ultimate payer, ranging from the insurance company to self-insured organization and/or employer. There are myriad arguments put to the adjusters against use of a psych professional. They range from the typical 'waste of money, never works' argument, to concern that there may be some type of ADA claim made for perception of disability. Not only must the TPA provide positive, instructive, timely service to and for the injured/recovering worker, they must also do their best to keep the 'paying customer' happy with the services provided. The pressure upon the TPA can at times be significant. Some have referred to this as "getting it from all sides". The situation is exacerbated by many of the business issues created by the downward pricing pressures for TPAs, the move towards flat rate, life of claim pricing and "best practices" espoused by remote brokers with little knowledge of specific claims and less than optimal information about the specific claim jurisdiction. TPAs must make difficult choices in their business; how many to employ, what skill and accomplishment level of these staff members, how much to invest in technology and where to find cost cuts looking in every conceivable place to name a few. In this context, the adjusting professional must weigh the potential benefits for the recovering worker of involving psychological professionals in a claim against the additional costs for the client and potential reduction in satisfaction of the client. Not an easy balance to achieve in all cases.

Read the article @