Early management of mental conditions in comp claims helps recovery

CHICAGO — Mental health claims represent 2% of total claims in workers compensation but cost 3.5 times more and last over 3.5 times longer than nonmental health claims, making mental health a top issue to watch in workers compensation.

And such claims are expected to increase in states such as New York and loosen parameters on what constitutes a mental injury claim, said Max Koonce, Bentonville, Arkansas-based chief claims officer at third-party administrator Sedgwick Claims Management Services Inc., who spoke Monday at the Risk & Insurance Management Society Inc.’s Riskworld annual conference.

Such claims are divided into two categories: one where the mental health condition is the primary ailment and a second where mental health coincides with a physical injury, such as when managing depression or stress becomes a part of the worker’s recovery from an injury or surgery, he said. Both are on the rise, he said.

Early engagement of behavioral health specialists continues to be key, he added.

“If you have a behavioral health specialist engaged in a claim that involves either primary or secondary component of mental health. You do that within the first 90 days, it’s a 40% reduction in the days off of work. And if you do it within the first 90 days, compared to doing it after 180 days, it’s a 70% reduction in the number of days off work,” he said.

A best practice has been to have all nurse case managers trained in mental health and to ask questions at the onset, according to Beth Burry, Richmond, Virginia-based Head of Managed Care for Sedgwick, who said there’s interconnectedness between an injury, mental state and sentiments about work.

“What we know to be true is that when there is a concurrent mental health condition, it’s going to impact the way that that employee feels about their return to work and it’s going to impact their feelings about how their recovery from their medical condition is going,” she said.