According to the New Jersey Workers’ Compensation Rating & Inspection Bureau, over the most recent five-year period total incurred costs for head injuries were $113,000 per claim; per claim costs for concussions during the same period were $83,000. Those costs suggest a lot of time away from work for New Jersey’s head-injured workers.
Many of the injuries involved psychosocial issues not identified until well into the claim. Research shows that these issues significantly delay and impede recovering and returning to work.
With that as background, let us propose a thesis:
Our nation’s current system for treating injured workers with mental health issues is uncoordinated, overly fragmented, highly wasteful and does not focus enough on speedy return to work. There is a critical need for a more systemic approach as well as an integrated coterie of clinicians and practitioners, trained in workers’ compensation, whose goals are to provide compassionate treatment with a steady return to work trajectory.
The issue is compounded by the way claim adjusters, supervisors, nurses and defense attorneys view psychological issues. No one wants to ”buy a psych claim,” and many believe that referring a claimant for behavioral health treatment does nothing more than create a lifetime annuity for a psychologist. Time and again this view has been proven correct.
What to do about that? Ay, there’s the rub. For in that question lies a host of difficulties. These, for instance:
- Most mental health professionals do not understand workers’ compensation. They do not realize either its statutory requirements or the concept of maximum medical improvement. They have spent many years being trained to treat the entire person. The players are the patient and the therapist, and it is like sitting on a two-legged stool. They do not fathom that, in workers’ compensation, the stool has five legs, with the other three occupied by the employer, the treating physician and the claim adjuster.
- Too often, by the time an adjuster or nurse recognizes that psychosocial issues may be impeding recovery and return to work the claim may have gotten a little long in the tooth; it could be months old, or more.
- It can take a claim adjuster weeks, in rare cases, months, to find a psychologist and schedule an appointment. It can also take weeks or months for a report to make it back to the file. Moreover, finding a clinician with even a smattering of workers’ compensation knowledge or experience is often problematic (See 1, above).
- Because there is no mental health electronic health record system for workers’ compensation, every report is its own island, sometimes good, sometimes bad.
- Everything is paper-based, which wastes claim adjuster time and increases expense.¹
- Although psychologists understand the value of work as therapy, many see no reason to help coordinate early return to work with employers, claim adjusters or medical providers
These are deep and difficult considerations. Tomorrow, we’ll describe how we created an entirely new approach that successfully addresses each of them.
¹ Claim adjusters also report that a not insignificant number of these reports are essentially unreadable, because they are handwritten.