Mental health looms large in Workers' Compensation

While the idea of treating the "whole person" in a Workers' Compensation claim was gaining momentum before the pandemic, fear of "buying the psych claim" or company cultures that were not open to talking about mental health led to some resistance. The pandemic, however, has forced a new era of workplace safety, not only for physical safety but also for the mental health and wellbeing of employees.

Employers are struggling with the effects of increased substance abuse, anxiety, depression, and insomnia among employees. The country's opioid crisis, which has challenged employers for years, is worse. In the 12-months ending in May 2020, there were 81,000 fatal drug overdoses - the highest number ever recorded. The National Council on Compensation Insurance (NCCI) reported a 10% increase in opioid utilization in Workers' Compensation during the second quarter of 2020, bucking quarter-on-quarter declines previously seen.

It's understandable that mental health considerations are looming larger than ever. Employees are rattled by economic uncertainty, the abrupt shift to remote working, balancing work and childcare, new ways of collaborating, personal or family illness and death, exhaustion, burnout, and social isolation. Those on the frontline experienced stressors never before imaginable - a sense of helplessness as thousands of patients died, loss of colleagues, fear of contracting the virus, and isolation from their families. And experts say this distress is not limited to the duration of the outbreak but will persist for years to come.

All of this has brought a laser focus on mental health as employers experience the impact on the workplace. The National Safety Council (NSC)* is calling for a new narrative around the definition of workplace impairment, an action supported by 93% of employers in a recent NSC survey. With over 90% of employers concerned about mental health and chronic stress impacting their workers' fitness for duty, the NSC urged "that employer policies and procedures outline 'workplace impairment' as anything that could impede one's ability to function normally or safely as a result of a number of factors - from chemical substances, such as alcohol, opioids or cannabis, to physical factors like fatigue, as well as experiencing mental distress and social factors like stress."

The implications for workplace injuries are noteworthy:

• Working and living in a heightened state of stress for an extended duration makes it more likely that a worker can be injured.
• Unrelenting stress can make recovery longer and more difficult.
• In many ways, there are parallels between the effects of the pandemic and the conditions that seriously injured workers face. Life becomes uncertain, questions arise about having enough money, workers who are dealing with a mental health condition are more likely to develop chronic pain, and chronic pain can lead to depression, anxiety, or insomnia.
• The likelihood of substance abuse increases.
• Prolonged recovery and delayed recovery at work can extend the claim duration and cost far beyond what it should be.
• Communication, empathy, and regular contact from the employer are keys to understanding what the injured worker is going through.

What employers can do

Employers have figured out how to shift some of the typical in-person Employee Assistance Programs (EAP) to virtual offerings, offered telehealth mental health sessions, identified online platforms that address common problems of stress, anxiety, and insomnia, trained managers who work with remote staff how to identify and communicate with workers who are struggling, offer voluntary virtual social activities, increase education about mental health awareness, and make sure employees know the resources available and how to access them. Creating a workplace culture that promotes mental health resources and encourages employees to take advantage of them lets employees know they are not alone and can seek help without stigma. It takes constant effort and innovative ways to reach employees.

For the injured employee, the issue is even more sensitive, as pointed out in a new white paper, To Best Treat a Worker's Injury, Look for a Broken Spirit, Not Just a Broken Bone by Coventry, a leading provider of care-management and cost-containment solutions for Workers' Compensation. While the work comp system focuses on the physical injury, it's easy to miss the mental ones, that might be harder to spot. The authors note, "Today, a comprehensive approach that identifies and meets an injured worker's needs is more important than ever because the coronavirus pandemic is blanketing everyday life with added stresses that threaten to imperil a worker's recovery."

Recognizing that early intervention is a key driver of good outcomes for both employee and employer, the authors suggest that insurance adjusters, case managers, and other stakeholders ask a series of questions early in the claims process to identify possible mental health concerns that could impact a claim's progress and a worker's recovery. Further, they note that "looking under the hood of a claim" can provide insight into whether mental health challenges are threatening to complicate recovery.

The paper also addresses the issue of compensability, which is complicated. It will vary by state and the specific circumstances of the claim. While it's an important part of the discussion with the adjuster, the mental health challenges that may emerge after a worker has been diagnosed with a physical injury cannot be ignored. To do so can mean the difference between a claim that is closed in a few months and one that could go on for decades.

*NSC resources on promoting employee mental health and wellbeing