Best Practices, Claim referral

When Should Adjusters Refer Claims For Mental Health Evaluations?

As we roll out Workers Compensation Psychological Network to New Jersey’s insurers, third party administrators, self-insured employers and defense attorneys, we are often asked how to tell if a claim needs referring, as well as how to how to decide where to send the referral.

Well, in order to provide the best possible service, we believe whoever you send claimants to for psych evaluations and/or treatment should understand a few things. Here’s what we understand:

  • We understand MMI, and we know you want your claimants to reach it as soon as possible. We do, too. In a limited number of sessions we can achieve MMI sooner, faster, and smarter.
  • We understand Permanency Benefits, credits and the importance of a deeply detailed patient history. In our first session we will dig down to discover in as much detail as possible the background of the person we are seeing. This information is vital to bringing the claim to a fair and reasonable outcome for you and the claimant.
  • We understand that there is an epidemic of head injuries in New Jersey today and that most head injuries can reach MMI satisfactorily and quickly given the right treatment.
  • We understand that you need information in real time, which is why we’ve built New Jersey’s first online Claimant Referral and Electronic Health Record system for mental health issues.
  • We understand that most claimants who need mental health treatment can return to work in some modified duty capacity as they recover. That’s why our clinicians have been trained in how to work with you, the claimant and the claimant’s employer to find the right modified duty, thus lowering the cost of indemnity payments immediately.
  • Finally, we understand that, although claimants may benefit from mental health treatment, in many cases the cause of their distress is not work-related. In our Initial Psychological Evaluation we are expert in determining if a mental health issue “arose in the course of employment.”

When should you make a referral to us? The answer is when you notice in the claim any of the following:

  • Complex head injury
  • Concussion diagnosis
  • Chronic and/or continuing acute pain
  • Severe depression
  • High anxiety
  • Fear of returning to work
  • PTSD diagnosis

We understand that therapy has to fit the person. We are expert in:

  • Cognitive Rehabilitation
  • Biofeedback
  • Psychotherapy
  • Neuropsychology

We would welcome the opportunity to explore all of the ways Workers Compensation Psychological Network can work for you. Your time is precious. We won’t waste it.

This is our pledge to you ­– Recovery: Sooner, Faster, Smarter.