Legal Analysis

Exercise Caution With Mental Injury Claims

Employers must recognize that purely psychological injuries can be compensable under certain circumstances.
By: | September 19, 2014 • 2 min read

The Court of Appeals of Virginia recently upheld the awarding of workers’ compensation benefits for a United Parcel Service Inc. delivery driver who claimed post-traumatic stress disorder after happening on a gruesome homicide at the home of a regular customer.

Takeaway

When a physical injury occurs, employers usually have a panel of medical doctors ready to provide to the claimant, so that the employer can direct the injured worker to a reliable, hopefully conservative, physician who can treat the employee’s injuries. Typically, employers do not have panels of psychiatrists or mental health care professionals ready to provide to an employee who has suffered a purely psychological injury. Employers must recognize, however, that purely psychological injuries can be compensable, and that they should have panels of mental health care professionals ready to provide to an employee if such an injury is claimed. Immediate treatment could make the difference between a quick return to work and an expensive period of disability.

The Case

In United Parcel Service, Inc., et al v. Prince, Record No. 0006-14-2, Court of Appeals of Virginia (Sept. 9, 2014), the employer was faced with a purely psychological injury. Prince was a delivery driver for UPS.

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Ms. Fassett was one of his regular customers. Prince had made deliveries to Ms. Fassett two to three times a week for approximately ten years and had a good relationship with her.  On January 7, 2013, Prince arrived at Ms. Fassett’s home for one of his regular deliveries. What he found when he arrived was a gruesome scene. He found Ms. Fassett lying in the doorway of her home. She had been shot several times. What was left of her face was covered with blood and shrapnel. Prince alleged that he had been terrified, as he did not know if the perpetrator was still on the premises.  Prince was subsequently diagnosed with post-traumatic stress disorder.

Court Findings

The Court of Appeals of Virginia affirmed the Virginia Workers’ Compensation Commission’s ruling that the claimant’s purely psychological injury was compensable. The Court recognized that the events confronting Prince constituted an obvious sudden shock or fright sufficient to constitute an injury by accident. As a result, Prince was awarded medical and wage indemnity benefits.

Psychological injuries are often the result of circumstances completely outside of the control of the employer. Employers, however, must be ready to respond to such claims when they arise. A proper panel of mental health care providers places an employer in a position to immediately respond to such a situation.

John T. Cornett Jr. is an attorney specializing in workers’ compensation defense at Lynch & Cornett P.C. in Richmond, Va. He can be reached at [email protected]

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]