Test Your Mental Health Knowledge

 

Are you in a mental state? Confused? Good news; we are here to help! Workers’ compensation claims involving physical injuries are complicated enough, but those with mental conditions can be a nightmare. Evaluating mental health claims is a tricky business for many. An X-Ray won’t indicate whether Joe’s anxiety is directly related to a severe fall through a roof he sustained at work last month, or if Susie’s heart attack can be attributed to her job stress.

Nevertheless, the increase in depression, anxiety and other mental health conditions among the U.S. workforce is a reality and requires claims handlers to have a solid understanding of these claims. Read on for information to help. ALERT: there will be a quiz later in this post!

Variability of Mental Health Coverages

Just as each jurisdiction has its own separate workers’ compensation system, each also has different rules regarding mental health conditions. They may be addressed by statute, regulations and/or case law, according to a study by the National Council on Compensation Insurance.

While each jurisdiction’s handling of mental injuries is different, they generally fall into one of three broad categories:

1. Physical/mental injury — the mental condition develops after a physical injury has occurred. For example, a worker loses a leg in a workplace injury and becomes depressed over the disfigurement. The mental injury must be linked to a physical injury that happened on the job.
2. Mental/physical injury — the mental condition manifests itself in a physical way; i.e., the worker develops a mental condition as a result of the job. A heart attack that results from job stress is an example.
3. Mental/mental injury — the mental condition is a result of job-related psychological trauma. An employee who witnesses violence toward a coworker and develops fear, anxiety or posttraumatic stress disorder could be compensated under this category.

But even within these categories, states have differences in terms of how and when they provide compensation. For example, within the mental/mental category, some states have statutory language that allows compensation for nonphysical mental injuries or stress under limited circumstances. But they may differ in the degree of evidence required as proof.

The fact that the thresholds for proof are different, as well as other differences among jurisdictions makes evaluating these claims that much more difficult. It requires a highly trained expert to determine if a worker’s mental condition is likely compensable.

Quiz Time

Knowing the requirements for mental health compensability for all 51 jurisdictions would be nearly impossible for most of us. However, claims handlers should at least have a rough idea of the mental health coverage available in their particular state.

That said, here is a short quiz to help determine how well you understand your state’s handling of mental health conditions in the workers’ compensation system.

• • Does your state allow workers’ compensation coverage for mental health conditions?

• • Does your state exclude coverage in any of the three categories mentioned above?

• • What is the degree of evidence required in the burden of proof?

• • Who is allowed to diagnose or offer evidence of a mental injury?

           • What, if any, exclusions are there to the mental health coverages offered?

Evaluating Mental Health Claims

Ten states require a licensed psychologist to diagnose the injured worker for compensable mental injuries. Payers in the other 41 jurisdictions would be wise to do likewise, as these experts are among the few that can truly determine the validity of an injured worker’s mental health claim.

Here’s an additional caveat that can muddy the waters in evaluating mental health claims; some states require the use of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders in diagnosing mental injuries.

In states where mental/mental injuries can be covered, most exclude stress arising out of personnel actions. Imagine trying to understand whether Fred’s anxiety is due to the gun fight he witnessed in his employer’s parking lot or the demotion he was given for poor customer service scores.

In addition to the requirement that a mental/mental injury be ‘the predominate’ or ‘substantial contributing’ cause to be compensable, some states also say the degree of mental stress must be considered ‘extraordinary.’ There could be a fine line between ‘ordinary’ and ‘extraordinary,’ especially for the lay person.

One more example to underscore the complexity of the various rules and regulations of mental health claims: Colorado is among the states that allow compensation for mental/mental injuries. To be compensable, ‘competent evidence’ is the degree of evidence required. As NCCI explains it: “accident,” “injury,” and “occupational disease” shall not be construed to include disability or death caused by or resulting from mental or emotional stress unless it is shown by competent evidence that such mental or emotional stress is proximately caused solely by hazards to which the worker would not have been equally exposed outside the employment.

Conclusion

Mental health workers’ compensation claims need to be carefully scrutinized by people who truly understand the psyche of the injured worker and the variety of rules among the jurisdictions. A licensed psychologist who works solely within the workers’ compensation system is your best bet.

Ascellus – Integrated Medical Case Solutions – is the premier behavioral medicine network for pain and trauma response with evidence-based outcomes and a proven track record for transforming workers’ compensation cases. Ascellus makes intervention efficient with a national network of 1,500+ psychologists and psychiatrists in all 50 states.

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