Tag Archives: assessment

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.

Early Intervention: Good For The Injured Worker, And It Saves Money, Too

It’s long been known that workers’ comp claims in which behavioral health issues are present cost more than those without such issues. Often a lot more. This month’s issue of Health Affairs reports on a Canadian Study that found that the average cost for a “mental health high-cost patient” was roughly 33 percent greater than the average cost for other high-cost patients. The authors suggest that intervening early when behavioral health issues are first detected can mitigate these higher costs.

Also, the Robert Wood Johnson Foundation’s Health Policy Snapshot, published in March 2013, examined the prevalence of mental disease in the U.S., and described how early treatment and intervention can improve lives and ultimately lower related health care costs.

Patients and payers are best served when screening occurs during the first month of any workers’ comp claim involving head injury or when the claimant is depressed, overly anxious or fearful. These can delay return to work and increase the cost of the claim. Intervening early leads to Recovery: Sooner, Faster, Smarter.

There Is A Need For Better Psychosocial Intervention In Workers’ Compensation

This morning, Workers Comp Insider, the Grand Daddy of workers’ compensation blogs, published an illuminating post focusing on why workers’ comp claims professionals wait far too long to engage qualified psychologists.  This, from the opening of Are We Only Paying Lip Service To Psychosocial Issues In Workers’ Compensation?:

It is a cliché in the workers’ comp industry that claims adjusters never want “to buy a psych claim.” Perhaps that’s why they rarely resort to psychologists until the horse is out of the barn and grazing four pastures over. By then it’s a last resort kind of thing.

The Insider goes on to say that claims payers and psychologists just don’t understand each other. It chides those claims adjusters who settle for asking only the basic questions suggesting that “digging deep” and

peeling the injured person’s personality onion to discover what really matters will allow for early detection of those relatively rare cases where speedy referral to a qualified psychologist might make all the difference.

We couldn’t agree more, yet lest we with the PH. D.s after our names begin to feel too comfortable, we come in for some sharp criticism, too. Most of us “know not even the first thing about workers’ compensation and give every indication of being proud of it.” Ouch.

The blog post suggests that we and the payers need to come together to build a system that works for everyone and that if claims adjusters are attuned to the subtle nuance inherent in a good conversation with an injured person, then perhaps certain signs will become apparent that indicate early psychological intervention is warranted.

Part of that coming together requires trust on both sides. The Insider suggests that a sign of trust on the side of the payers would be to adopt a  policy that “entrance into a payer network should not be determined solely by a license to practice and the forced acceptance of a ridiculously low fee. Quality and results matter.”

Finally, the post tells payers that they have a whole lot of educating to do, education that should start today. Why?

Because identifying early and resolving quickly the factors that have the potential to turn physical injuries into mental health problems will save employers, the folks who pay the bills, a significant amount of money and adjusters, whose goal it is to put the toothpaste back in the tube, considerable otherwise wasted time.

That, in a nutshell, is why we created Workers Compensation Psychological Network. To partner with payers for the betterment of injured workers to build a better system – Sooner, Faster, Smarter.

Pain Pathways and Treatment Options

In our last blog post (link to post), we focused on chronic pain and suggested that New Jersey’s workers’ comp claim system did a poor job of helping injured workers who are chronic pain sufferers to recover.

But there are two kinds of pain injured workers face: Chronic and Acute. The first step in pain management is knowing which is afflicting the patient. Seems simple? It’s not. Make a mistake here, and you can harm the patient.

WCPN Psychologists first perform a comprehensive evaluation to determine the level and type of pain. Then, working in active a steady communication with the patient’s physical health provider, they begin a targeted treatment plan to help restore the patient to high functionality.
But what’s in that “comprehensive evaluation?” How do they assess the current mental well-being of the patient, so the best treatment plan can emerge?

Well, first of all, there’s no black box. No Wizard behind the curtain.

Together, we and our patient begin the assessment journey. First, we need a good history. This includes an individual and family medical history, as well as the patient’s educational history. The fancy name for this is a “Biopsychosocial Assessment (BA).” Here are some of the things that go into conducting the BA:

  1. We need to identify and gauge the role of pre-existing conditions.
  2. We discover the patient’s levels of anxiety and depression.
  3. We consider the patient’s personality factors that might be affecting his or her perception of pain in daily life.
  4. We review prescription medication use or abuse.
  5. By listening closely, we cull out the patient’s pain history.
  6. We identify specific functional behaviors the patient’s pain is affecting.
  7. Through all of this we introduce appropriate coping skills and the concept of medication reduction. Here, the patient begins to learn about the Mind-Body relationship, after which, as part of treatment, we can begin Awareness Training.

Through a good Biopsychosocial Assessment and follow-on treatment, our constant goal is helping our injured worker patient walk down Recovery Road and return to work as soon as health allows. WCPN Psychologists aim for Recovery: Sooner, Faster, Smarter.