Should Workers Comp Psychological Injuries Count As Claims?

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The Complicated World of Workers Comp Psychological Injuries

One subject that has long been the bane of claims adjusters is workers’ comp psychological injuries.

picture of Sigmund Freud workers comp psychological injuries

Earlier this week, I included mention of a session at the upcoming WCRI Annual Conference on mental injuries resulting from an on the job injury.   Please do not think that I disbelieve or have never accepted a resulting mental injury from a Workers Comp file.

I have accepted and paid benefits on Physical> Mental claims.  A brain-injured claimant can easily have mental concerns for many years after a Workers Comp injury.   These types of claims baffle many new adjusters.

Two schools of thought exist in many claims departments.  One opinion is that no psychological injuries should be accepted on any claim unless a very extreme circumstance exists on the claim.

Some state Workers Comp courts have ruled that psychological injuries should be accepted in some cases including a mental injury that results from no physical injury.

The four types of injuries in Workers Comp are:

  • Businesswoman Workers Comp Psychological Injuries lying unconsciously
    StockUnlimited

    Physical > Physical – an employee physically injures themselves which results in a physical injury that must heal over time. This type of injury is the most prevalent in Workers’ Compensation.  If a treating physician deems a person to be unable to return to work, and the claim is considered compensable, then the applicable benefits are usually paid on the claim

  • Physical >Mental – an injured employee incurs a psychological injury from the aspects of an on the job injury. This type of injury comes from the physical >physical injury in the previous bullet point.  Many claim departments remain, staunch defenders, that no mental injury results from a physical injury.  Many claim departments bristle when asked to pay for psychological benefits.   One can find many cases where a Workers Comp court decision was rendered where mental injury benefits are ordered paid to the claimant.  This remains a strong point of contention in some files.
  • Mental > Mental – the most complicated type of claims for adjusters to handle consists of an employee having a purely mental claim from the workplace. Some Workers Comp courts have ordered benefit payments on mental > mental claims.  Workers Comp claims departments usually litigate these types of files before payment.  Many of these types of claims are appealed if the claimant or insurance carrier does not prevail in litigation.
  • Mental > Physical – a very rare file where a mental injury results in a physical injury. The one main controversial area with this type of claim is Reflex Sympathetic Dystrophy.   The definition of RSD has changed over the last few years to include Complex Regional Pain Syndrome.   A claims adjuster may never see this type of injury in their career

Please remember that I am writing this article in laypersons terms from my own experience and the experience of my co-workers over the years.   I am giving no medical advice concerning Workers Comp psychological injuries.

 

©J&L Risk Management Inc Copyright Notice

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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