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Digital EditionEarly Mental Health Support Can Cut Workers’ Comp Claim Duration by 70%: Sedgwick
Mental health claims represent less than 2% of workers’ compensation cases but can extend claim duration by three times, while early intervention with behavioral health specialists can reduce claim duration by 60-70%, according to findings recently shared by Sedgwick in their commentary paper, “Unveiling the Hidden Struggles: Mental Health and Workers’ Compensation.”
The findings of the commentary paper were discussed with Max Koonce, chief claims officer at Sedgwick, during a Sedgwick podcast episode, hosted by Kimberly George, global chief brand officer at Sedgwick.
Workers’ compensation coverage for mental health conditions varies significantly by state. Koonce explains that there are two primary categories of mental health claims: “mental-mental” claims, which don’t involve physical injury, and “physical-mental” claims, which arise from a physical injury covered under workers’ compensation.
“Virtually all [states] to some degree or another allow claims for mental health if there is a physical injury associated with that individual claim,” Koonce noted. However, mental-mental claims are permitted in only a handful of states, including California and New York, which tend to have more progressive workers’ compensation laws.
Many states have expanded coverage specifically for first responders, recognizing the unique mental health challenges these professionals face, Sedgwick noted.
“These are individuals that are working for the public in general… they’re exposed to extreme conditions from the standpoint of work,” Koonce explained. Some states have even established presumption laws for first responders, making it easier for them to receive coverage for mental health conditions.
The prevalence of mental health claims varies accordingly. In states allowing mental-mental claims, the percentage can reach around 5%, while in states that only permit physical-mental claims, the figure drops below 1%, according to Koonce.
The Significant Impact of Mental Health on Claims Outcomes
Despite their relatively low incidence, mental health components can dramatically affect claim trajectories when they do occur. When mental health issues accompany physical injuries, the impact is substantial.
“When you have that involved in the process, you recognize that can impede the return to work. It can lengthen the time of disability. It can put you on a different medical care plan,” Koonce said.
The additional treatment requirements and challenges with return-to-work processes contribute to increased costs and extended disability durations. These patterns mirror what employers are seeing in disability management, where George, noted that “mental health claims are within the top three, most likely, number two behind pregnancy for disability claims.”
This extended duration applies across demographic groups. “Regardless of men, women, age, we really do see this prevalence across the workforce of mental health challenges,” George said.
Early Intervention Delivers Substantial Benefits
Sedgwick’s data revealed a compelling finding: the timing of behavioral health intervention dramatically affects outcomes. Claims that received behavioral health support within the first 90 days can reduce a claim duration by up to 70 days, as opposed to claims where intervention began after six months.
“When it was in the first three months or first ninety days of the claim, you saw a significant impact from the standpoint of how we compare to those claims that did not get treatment until after six months or longer,” explained Koonce.
The data points to a clear recommendation for claims management: adopt a holistic approach that addresses both physical and psychological aspects of recovery.
“The holistic approach in workers’ compensation where you’re looking at the bio, the social aspect of it, is becoming even more critical in today’s environment than I believe it was in the past,” Koonce concluded. This approach offers “a chance to have a very positive impact on that injured worker and helping them return to their pre-injury situation as soon as possible.”
Read the findings from the commentary paper and listen to the podcast episode on the Sedgwick website. &
