Recognizing PTSD and Its Doppelgängers in Workers’ Comp: The Complex Path to Recovery

Recognizing and treating PTSD will be key for workers’ comp professionals as more states expand coverage for the condition.
By: | September 19, 2023
A distressed woman in a wheelchair speaks to her doctor

There’s been a push to expand coverage for post-traumatic stress disorder and other mental health conditions within the workers’ compensation industry in recent years.

Currently, 34 states require employers to cover some level of PTSD treatment, usually for first responders, who are more likely to be exposed to the kinds of traumatic events that can trigger the condition in people on the job.

But an uptick in workplace violence and mass shootings has led some advocates to argue for expanding the coverage to include additional professions, like teaching, that could be more vulnerable to these kinds of attacks.

“[Workers’ comp] regulators (and legislatures) are struggling with how to incorporate mental health under the WC umbrella,” Dr. Michael Lacroix, medical director for The Hartford, said in an email. “Mental illness is increasingly recognized as a disability.”

The diagnosis of PTSD is complex, often requiring a psychiatrist with specialized education and years of experience. And the condition can mimic other, similar mental health disorders. Workers’ comp professionals need to be prepared to recognize PTSD and appropriately treat it as the condition becomes more commonly accepted within the industry.

Lacroix will speak on PTSD within workers’ compensation during the session “Not Everything That Quacks Is a Duck: PTSD and Its Doppelgängers” at the 2023 National Comp conference. He and his copresenters — Melina Griss, also a medical director with The Hartford, and Nikki Wilson, senior director of clinical pharmacy services and solutions with Mitchell — will speak on how to diagnose PTSD, how it can be treated and how employers can help their workers process traumatic events in the hopes of avoiding long-term issues.

PTSD’s Doppelgängers

One of the challenges of treating PTSD within workers’ compensation is the fact that the condition is overdiagnosed. General physicians may not have enough knowledge to distinguish PTSD — which occurs after life-threatening situations, serious injuries or sexual violence and persists for 30 or more days — and general post-traumatic stress, which can manifest after a number of different circumstances but usually resolves.

Dr. Michael Lacroix, medical director, The Hartford

“Diagnosis of PTSD is complex, and most general practitioners (who spend an average of eight minutes with the average patient) basically hear ‘trauma’ and ‘can’t sleep’ and jump to a PTSD diagnosis,” Lacroix said. “That’s a problem.”

Workers’ comp teams should involve clinicians who have the experience and education necessary to accurately diagnose PTSD early on in a claim. That way, they can make sure workers are on the right treatment path.

“If you have employees who present with a PTSD diagnosis, make sure that the diagnosis is made by either a licensed psychologist or a licensed psychiatrist, not a general practitioner (GP) and master’s level therapists (LCSWs, LMFTs etc.),” Lacroix said.

It’s important for workers’ compensation professionals to recognize when they’re treating PTSD and when they’re treating something else.

Other conditions may have similar symptoms, and some drugs may have side effects that present similarly to the condition. Lacroix says many of PTSD’s symptoms have significant overlap with anxiety, depression and other mental health disorders. Pharmaceuticals, too, can cause side effects that mimic PTSD. Wilson plans to share a list of medications that could mimic PTSD during the session.

“Things like traumatic brain injury and substance use disorder can look like PTSD,” Wilson said. “Some drugs can actually mimic the symptoms of PTSD.”

Treating PTSD in Workers’ Comp

Once workers’ comp professionals have confirmed that an employee is suffering from PTSD, they’ll need to figure out how best to treat the ailment.

“Employers can assist by making sure that employees with genuine PTSD can access appropriate treatment under their health care insurance. During our panel, we will address the kinds of treatments that have been validated in their presentations,” Lacroix said.

Since PTSD isn’t considered a standard workers’ compensation condition, employees seeking treatment for it may encounter unexpected obstacles. The drug may not be recognized by formularies, for instance, so case managers might have to do some extra work to help get them the treatment they need.

“Some of these medications aren’t typically covered within a workers’ comp drug formulary automatically,” Wilson said. “If a payer is accepting PTSD on the claim, they can work with a pharmacy benefits manager, if they have one on board, to determine what will be appropriate so that the patient doesn’t have any roadblocks to getting appropriate medications.”

Nikki Wilson, senior director of clinical pharmacy services, Mitchell

Another challenge: PTSD, like many other mental health conditions, requires an individualized treatment approach. “It’s a tricky science,” Wilson said. “There’s a lot of balance and finding out what works for that patient and a lot of reevaluation.”

Bringing PTSD Awareness to the National Stage

During their session, Wilson, Lacroix and Griss will detail how workers’ comp professionals can recognize and treat PTSD and how they can address traumatic stress in the workplace. There are no simple solutions, but they’ll detail all of the clinically validated methods out there. Treatment for PTSD is often complex, requiring a whole-person approach.

“There isn’t a quick fix for it with these types of medications that fall under the treatment of PTSD,” Wilson said. “Really, treatment for any mental health disorder — but in particular PTSD — is complex and should be individualized.”

Attendees can expect to learn how to distinguish what kinds of events can cause PTSD and what events may be traumatic but don’t meet the diagnostic criteria for causing PTSD.

“Toxic work environments, problematic relationships, financial reversals and bankruptcy do not qualify for a PTSD diagnosis. While these are subjectively traumatic, they do not qualify under the diagnostic definition,” Lacroix explained.

“We all experience trauma, and when we do, we experience post-traumatic stress (which is not pleasant), but most of us recover — and may even become more resilient.”

Employers who recognize these types of traumatic incidents can step in to help workers process trauma. Strategies like critical incident stress debriefing can go a long way toward preventing PTSD from developing. The panelists will detail many of these strategies as part of their discussion.

“​​There are ‘crisis response’ strategies that employers can access and that can ease the process of recovery from post-traumatic stress,” Lacroix said. “Trauma itself is part of life, and most people recover. Not all stressful events lead to PTSD.” &

“Not Everything That Quacks Is a Duck: PTSD and Its Doppelgängers” will be held on Sept. 20 at 3:45p.m. Learn more here.

Courtney DuChene is a freelance journalist based in Philadelphia. She can be reached at [email protected].

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