The escalation in psychological claims over the past 10 years has been dramatic. Experts now estimate that the cost represents approximately 40% of claims on the average long-term disability plan.
However, managing psychological claims requires a different mindset than managing physical claims. If an employee develops situational anxiety related to a life event (perhaps precipitated or followed by a workplace event), how can it be measured? How it can be fixed? And how long it will take to heal?
These questions are infinitely harder to quantify. Employers should keep the following points in mind when dealing with a possible psychological claim.
1. Distinguish workplace issues from disability.
Separate workplace issues from psychological issues and deal with the root cause. Too often, workplace issues are categorized as disability, leaving management issues unaddressed and striking fear into the hearts of managers. It’s okay to be upset when a spouse leaves or a close relative dies. However, these situations are life events, not disabilities, and being at work following these types of events can provide a useful social network and a degree of normalcy.
It’s important to make the distinction between life events and disabilities at the time of the claim. The value of having a good initial adjudication process cannot be underestimated.
2. Ensure an accurate diagnosis.
If the individual has a psychological illness, early identification, clear assessment and correct diagnosis are essential. This is often one of the complexities that prolongs psychological cases. According to recent research in the Journal of American Medicine, an estimated 40% of cases are misdiagnosed or underdiagnosed, resulting in incorrect or insufficient treatment, and more than 50% of cases do not receive guideline-driven care.
The initial steps in identifying a psychological illness are: making an accurate identification/diagnosis; providing an appropriate treatment plan and outcome-driven activities: and identifying the employee’s capabilities and limitations.
3. Arrange appropriate treatment.
Treatment is a very important component of psychological claims management and is one of the essential elements of successful recovery. A misguided or incorrect diagnosis or treatment plan can extend the duration of the disability.
For example, the signs and symptoms for depression and post-traumatic stress disorder (PTSD) may be similar, but the treatments are very different. If depression is missed, based on the assumption of a PTSD claim, then the therapeutic interventions may be incorrect and the chances of resolving the condition are marginalized.
4. Develop return-to-work plans.
It may be necessary to provide transitional return to work in order to ensure smooth reintegration into the workplace. An understanding of the employee’s psychological capabilities and how they relate to the job is an important step in developing and implementing such a plan.
5. Train supervisors to identify behaviour changes.
Supervisors are exposed to employees every day. When properly trained, they can learn to identify the signs and symptoms that may be related to psychological conditions.
For example, an employee with seasonal affective disorder did not recognize it in himself. Yet each year, in January and February, he began missing work or coming in late and was unable to concentrate. The supervisor recognized the return of the symptoms and pointed them out to the employee. The employee was then able to pursue early treatment and get back on track.
Establishing a pragmatic process to manage psychological claims more effectively can minimize the long-term impact on your workforce and improve outcomes for the affected employees, ending in a successful return to work.
Liz R. Scott is a principal with Organizational Solutions Inc., a disability management company.
lscott@orgsoln.com
> click here for a PDF version of this article
© Copyright 2010 Rogers Publishing Ltd. This article first appeared in the February 2010 edition of BENEFITS CANADA magazine.