Workers comp sector braces for surge in mental health claims

The stress of the coronavirus pandemic may cause mental health-related workers compensation claims to rise, particularly among health care workers and first responders, experts say. 

Employers can mitigate the risk of mental workers comp claims by offering  workers help through employee assistance programs, peer support networks and other behavioral health interventions. 

“Coping with stressful situations as a first responder and medical professional is part of the normal expectations of these types of vocations, but now that stressful situation has doubled or tripled,” said Helen Froehlich, Richmond, Virginia-based vice president of case management services at Genex Services LLC. “It’s really going to be a wait-and-see on how it impacts the claim numbers. I do think we should be relatively prepared that people will need our help.”

More than two-thirds of frontline health care workers will likely experience psychiatric symptoms, including post-traumatic stress, acute anxiety, substance abuse, depression and suicide, according to a study published in late March by the Journal of the American Medical Association. 

Nadine Kaslow, professor of psychiatry and behavioral sciences at Emory University in Atlanta, who has spent time with nursing staff at multiple hospitals during the pandemic, said nurses working in the intensive care unit face intensely stressful and profoundly painful situations. 

“They’ve witnessed so much death, working long hours, and they have to be everything to these patients because no one else is allowed in the room,” she said. “There’s no question that there is an increased risk for a variety of problems — anxiety, depression, acute stress disorder now, PTSD down the road.”

Since the pandemic began, Irvine, California-based Corvel Corp., a third-party administrator, has seen about a 12% rise in workers compensation claims with a mental health component and expects the trend to continue as the pandemic progresses. About three-quarters of the states in the U.S. will allow for mental-only workers compensation claims — often referred to as mental-mental claims — while the rest require a physical on-the-job injury before an associated mental condition can be considered compensable.

“We are starting to see uptick in those kinds of claims, both mental-mental in first responders and the health care sector in particular,” said Michele Tucker, vice president of enterprise operations at CorVel. 

The mental aspect of some of the claims relate to either COVID-19 exposure or a positive diagnosis that “seems to build over time,” she said. “I think we’ll continue to see that.”

John Hanson, an Atlanta-based senior consultant with Willis Towers Watson  PLC, also foresees an uptick in claims from first responders and health care workers who worked long shifts and were isolated from their own families, as well as claims filed by law enforcement officers and firefighters on the job during the unrest following the death of George Floyd in Minneapolis. 

The challenge for the workers compensation system, however, is that it was not set up to tackle behavioral health issues, Mr. Hanson said. 

“The comp system (doesn’t) have resources to adequately manage the expected increased volume in claims,” he said. “The magnitude of this crisis is … potentially unmanageable if we don’t adopt new approaches to the provision of (behavioral health) therapy.”

Employers are concerned with the behavioral and mental health of their employees, according to a study conducted in June by Willis Towers Watson. In a survey of 543 employers representing more than 5 million employees in the U.S., 47% said they plan to enhance mental health services and/or offer stress/resilience management services for their workforce. 

Employers who put into place specific programs aimed at treating mental health issues can also help workers obtain treatment right away without having to go through the red tape, said Dr. Teresa Bartlett, Troy, Michigan-based senior vice president of medical quality for third-party administrator Sedgwick Claims Management Services Inc., who noted that early treatment is “so pivotal” for mental health. Employees also need to be reminded of the benefits and resources — such as an employee assistance program and mental health benefits — that may be available to them, she said.

The University of Pennsylvania Health System took this approach by creating a digital platform to provide workers with immediate access to mental health care support (see story). 

Other options can include peer support programs, or even critical stress debriefing services, with health care providers leading discussions with workers over their stressful situations, said Washington-based Karen Thomas, director of case management innovation at CorVel. 

“The earlier the support is, the better it is in trying to remedy the situation,” said Melissa Burke, Southington, Connecticut-based head of managed care and clinical for AmTrust Financial Services Inc.

In New Jersey, pending legislation may offer mental health solutions for certain classes of workers through the state. S.B. 2551, introduced last month by Republican Sen. Anthony Bucco, would require the state’s Department of Human Services to establish a mental health program for first responders, health care workers and others in frontline positions during the pandemic, making the program available to workers regardless of coverage through private health insurance or workers compensation and allow them or their health care providers to submit claims for reimbursement. A companion bill, A.B. 4257, was introduced by Republican Rep. Aura Dunn in the New Jersey House of Representatives.

But these behavioral health issues are not limited to health care workers and first responders, Dr. Bartlett said. For example, grocery workers may encounter customers who do not use masks or maintain social distance, exposing them to potential germs. 

“That impacts you, and weighs on you heavily when you have to go home to a family and small children, and think what will it do to them,” she said. “Depending on what the exposures are in a workplace, there will be some of those mental claims.”

All employers need to be looking at how they can protect the emotional, mental and social health of employees, and pointing struggling workers to interventions, said Dr. Marcos Iglesias, Hartford, Connecticut-based chief medical director at Travelers Cos. Inc. 

“There was a huge number of the population at large that were facing mental health issues before COVID,” he said. “(The pandemic) has only exacerbated that, and none of us is immune to it.”

Employers that do not provide solutions to combat the mental health issues from the pandemic are “going to lose employees, going to have turnover, more claims, worse claims outcomes, not to mention legal implications,” Ms. Tucker said. 

“If no changes are made to the provision of behavioral health resources for folks in these risk categories, then you will have claims … and you will have a significant increase in the number of workers comp claims nationally,” Mr. Hanson said.

The comp industry may also see mental health claims attached to physical COVID-19 claims — with workers  claiming they have suffered from mental injuries as a result of acquiring coronavirus on the job — particularly in states that have created a COVID-19 presumption, said Saul Allweiss, founding partner of Allweiss, McMurtry & Mitchell in Tarzana, California.

“On litigated (claims), I think these physical-mental cases are going to be quite common — it’s low-hanging fruit,” he said. 

These mental claims can also be expensive to defend, at least in California, he said, adding that claims can “easily”  cost  $10,000 to $20,000.

Employers faced with coronavirus-related physical-mental claims may want to think twice about fighting the temporary disability or mental care associated with the claim, because it “will tend to mitigate any type of potential permanent disability that might … develop down the road,” he said.