Workers’ compensation claims adjusters are busier than the Ed Sullivan Plate Spinner. Running around with one or two hundred lost time claims would make anyone dizzy, but at the recent National Workers’ Compensation & Disability Conference (NWCDC) in New Orleans, presenters tossed the frazzled spinners a few more plates to shoot up on the sticks.
The issue? Psychosocial factors delaying claim resolution.
At one well-attended session, Marco Iglesias, Medical Director for The Hartford, and Robert Hall, Corporate Medical Director for Optum went into great detail about how psychosocial factors rear their heads in the claim process and how they impede recovery.
For example, consider these research statistics based on a study of 75,000 claims:
Time out of work increases 30% for a musculoskeletal claim with one co-morbid complication;
Duration increases 57% if the claim co-morbidity is depression;
According to The Hartford’s Dr. Iglesias, 10% of claims, the ones with all those psychosocial issues, cause 60% of claim costs;
At another presentation, attendees learned that Mental Health, Addiction and Obesity are the three comorbidities causing the greatest cost and time away from work.
Also, according to an AETNA presentation, 97% of depressed patients have a second co-morbid condition.
Research aplenty; solutions, not so many.
The pitch at the conference seemed to be two-phased. First, here are a number of factors, which, if present, can significantly delay recovery (see our Predictive Triggers post for more on this). Second, if you’re an adjuster or nurse case manager and you recognize any of these factors in one of your claims, put on your sensitive side psychology hat and provide gentle guidance and counsel to help the injured worker overcome the problems delaying recovery.
At the breaks after the sessions adjusters were talking in small groups about how this was all well and good, but it required increased time on claim, time they didn’t have. Also, many of them admitted that their claim resolution approach, honed over many years, veered more to the cut and dried than the touchy feely.
So, what should overworked adjusters and nurse case managers do with this fast-approaching, ever-enlarging, dead-ahead iceberg?
Well, there are three critical things to know when one suspects the presence of psychosocial triggers:
First, are they real?
Second, are they work-related?
Third, are they truly impeding recovery?
The only way to know with credibility the answers to those three questions is to have a qualified clinician conduct a thorough Initial Psychological Evaluation.
So, with all due respect to the excellent doctors who presented at the NWCDC, we suggest logging in to our claimant Intake & Referral Portal and referring these difficult claims with their thorny issues for a highly-reliable, speedy and comprehensive Initial Psychological Evaluation. The cost is only $450, and you’ll be glad you did it.
That’s all part of our pledge to you: Recovery – Sooner, Faster, Smarter!