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Stakeholders Increasingly Look to Psychosocial Risk Factors in WC Claims

Fear is a scary thing, especially among injured workers. Those who say they are afraid/scared/worried/anxious at the beginning of a claim were shown in a recent study to have average lost-time claim costs 3.5 times higher than those who didn’t and were also more likely to hire attorneys.

The analysis by Lockton is one of several recent reports that cite fear, and psychosocial issues in general, as one of if not the major cost driver in the workers’ compensation system. The Medical Director of insurance giant The Hartford was quoted recently as saying that text mining at his company found that the presence of fear-related words in adjusters’ claim notes had a stronger association with poor outcomes than lumbar fusion surgery.

A nationwide survey of claims leaders conducted by Rising Medical Solutions said psychosocial issues were noted as the biggest barrier to positive claims outcomes and that they drive up claim costs “far more than catastrophic injuries,” due to their delayed recoveries. A recent white paper generated from the study said the biggest roadblock to quick recoveries and lower claims costs “is the negative impact of personal expectations, behaviors, and predicaments that can come with the injured worker or can grow out of work injury.”

The white paper and additional recent reports are highlighting the magnitude of psychosocial issues in the workers’ compensation industry. Increasingly, stakeholders are finding ways to identify and intervene in these cases.

Defining Psychosocial Factors

The term psychosocial generally refers to behavioral issues rather than traditional psychiatric problems. Some of the more prevalent ones we see among injured workers include:

  • Depression/anxiety
  • History of childhood abuse
  • Perceived injustice
  • Fear avoidant behavior
  • Catastrophic thinking
  • History of substance abuse
  • Smoking
  • Obesity

Injured workers with these underlying issues typically have longer claim durations than would be expected for their work-related injuries. Their claims are often referred to as “creeping catastrophic”: a relatively simple injury that degenerates into chronic pain and involves multiple medical treatments and medications, often opioids.

Early ID/Intervention

Psychosocial issues are not dependent on the nature of the injury, meaning an injured worker’s medical report by itself won’t signal a claim as one with risk factors. But several large insurers and self-insured organizations are finding ways to identify these claims soon after an injury.

Albertsons Companies is in the 7th year of a program that voluntarily screens and offers help to injured workers with psychosocial issues. The company uses a third-party telephonic triage firm to contact the injured workers. Those flagged for intervention are offered cognitive behavioral therapy (CBT) health coaching as a benefit.

CBT, considered the premiere method of addressing psychosocial issues, involves learning skills that challenge and change the way people think and feel. This has been shown to be highly effective in improving the way people cope with pain.

The CBT-based program at Albertsons is facilitated through a collaborative multidisciplinary team approach that includes a psychologist from a national network, the treating physician, the company’s medical director, claims examiner and nurse case manager.

So far, approximately 9 percent of the 10,000 injured workers screened at Albertsons have been through the short-term coaching program. Company officials estimate the eventual savings in disability durations and medical spending could be as much as 50 percent.  

Nationwide Insurance is likewise looking to CBT to intervene with at-risk injured workers. A specialized team is being developed to focus specifically on those with psychosocial factors. The company plans to use manual scoring and predictive modeling to flag cases and then have the workers referred to qualified specialists.

Claims adjusters at The Hartford begin their process of identifying at-risk injured workers by asking them when they expect to return to work. Those who believe their recoveries will take longer than 10 days are asked additional questions to determine if there are underlying issues. Injured workers identified as having risk factors are targeted for a specialist team that uses phone calls along with a workbook and homework to learn coping skills.

It is heartening to see the industry’s focus turning to identifying and mitigating psychosocial issues among injured workers. With the right treatment by trained professionals, those affected can recover quickly and get back to functionality.

IMCS – Integrated Medical Case Solutions – is the premier behavioral medicine network for pain and trauma response with evidence-based outcomes and a proven track record for transforming workers’ compensation cases. IMCS makes intervention efficient with a national network of 1,000+ psychologists and psychiatrists in all 50 states.