According to a 2016 Workers’ Compensation Benchmarking Study survey, national claims leaders rank psychosocial issues as the number one barrier to successful claim outcomes.
A new white paper shows how claims advocacy principles at The Hartford, CNA, Nationwide, and Albertsons Companies are taming the effects of psychosocial issues and coaching injured workers to recovery and claim resolution. In order to understand these findings, it is important to take a brief look at what “psychosocial” is and, perhaps more importantly, what it is not.
The Hartford’s medical director, Dr. Marcos Iglesias, says that the “psych” part does not mean psychiatric issues, such as schizophrenia, personality disorders, or major depressive disorders. Instead, he points out, “we are talking about behavioral issues, the way we think, feel, and act. An example is fear of physical movement as it may worsen one’s impairment or cause pain, or fear of judgment by coworkers.”
The Hartford’s text mining has found the presence of “fear” in claim notes was more predictive of poor outcomes than a lumbar fusion surgery. Similar findings were recently cited by both Lockton and the Workers’ Compensation Research Institute (WCRI) which independently report that workers who express fear are at greater risk of poor outcomes.
There is no shortage of studies demonstrating the dramatic impact of psychosocial roadblocks and just how hard they are to manage. Lockton’s study directly links worker fears with high litigation rates. Another from the Journal of Occupational and Environmental Medicine found that injured workers with emotional distress, such as pain catastrophizing and activity avoidance, were seven times less likely than those in the low-risk group to return to work within three months.
Other conditions, behaviors, and predicaments include obesity, hard feelings about coworkers, troubled home life, the lack of temporary modified work assignments, limited English proficiency, and – most commonly noted – poor coping skills. Additionally, being out of work can lead to problems such as increased smoking, alcohol abuse, illicit drug use, and risky sexual behavior. Suicide rates have been observed to increase by a factor of six.
The national medical director for Albertson Companies uses a modified Linton tool for screening injured workers for psychosocial comorbidities. Approximately nine percent of screened workers receive specialist intervention, which is usually performed by a network of psychologists who provide health coaching consistent with cognitive behavioral therapy principles. This intervention method is short in duration and focuses on active problem-solving with the patient.
Albertson’s medical director cautions that, with the long-tail nature of workers’ compensation claims, it will take three or four years before the strategy’s impact can be effectively measured in claim outcomes, but she is optimistic. Her tentative estimate is duration of disability and medical spending will decline by 20 percent.
When peeling back the psychosocial onion, one can see how adversarial, compliance, and task-driven claim styles are 1) ill-suited for addressing fears, beliefs, perceptions, and poor coping skills and 2) less likely to effectively address these roadblocks due to the disruption they pose to workflows and task timelines.
This short report – “How to Overcome Psychosocial Roadblocks: Claims Advocacy’s Biggest Opportunity” – examines key best practices, skill sets, and training approaches organizations are using to screen for, intervene in, and effectively address psychosocial factors. Rooted in advocacy, these strategies treat the injured worker as a whole person to proactively resolve non-medical barriers to timely recovery.