Why Are Workers’ Comp Psychological Claims So Difficult to Adjust?
Yes, some of the most difficult claims to adjust are Workers’ Comp psychological claims. Let us answer the “Why?” question today. First, let us cover the psych claim matrix.
Workers Comp Psych Claim Matrix
If you happen to have a claims/risk background, my first suggestion is to LOOK @ your claims manual. You know, the manual on your laptop/desktop or on paper that covers this subject. Dust it off, whether electronically or on paper. I guarantee that the manual will cover this subject.
Always check with your supervisor before accepting or denying a Workers Comp psych claim, even if you are an experienced adjuster.
Condition (injury) – Claim
Mental – Physical – I have only seen this type of Workers Comp psych claim once or twice in my 40+ year career.
Mental – Mental – the most complicated claims to handle. Some states and certain job titles, such as EMTs, can make this a compensable claim.
Physical – Mental – this happens often, especially with serious or long-tail claims such as occupational disease claims.
Physical – Physical -does not fit in this matrix, just wanted to mention it. 99% of the claims fall into this category.
A plaintiff Workers’ Comp attorney firm provided a great analysis from a different viewpoint. Yes, hearing an opinion from “the other side of the table” can aid in one’s thinking about mental-based workers’ comp claims. A passage from his website is below on workers’ comp psychological claims.
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Why are these cases so hard to win?
Mental health injuries don’t show up on an X-ray. There’s no cast or crutches. Unfortunately, that invisibility often leads to reasonable doubt, especially for insurance companies. Insurers may argue that your condition is exaggerated or unrelated to work. Or, if you’ve struggled with mental illness before, they may claim your job isn’t the issue. Additionally, many people wait to seek help, making it harder to tie a mental health problem directly to workplace incidents.
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Bottom Line on WC Psych Claims
Workers’ Comp psychological claims have become more numerous in certain states since the start of the pandemic. Reaching out to your supervisor, defense attorney firm, or a psychological medical professional for their opinions s will always be the best way to handle these very complex claims.
