This article was co-authored by Shannon Kuznia, Commercial Insurance Claim Manager, and Anna Grossbach, DNP, RN, PHN, Director of Clinical Consulting Services.
Pop Quiz: Which of the following employees may have a workers’ compensation claim:
Answer: Likely only "c." And it still depends.
Minnesota is among a minority of jurisdictions that generally do not allow compensation for cases in which mental stress or stimulus produces a mental-only injury. However, Minnesota has made an exception for certain post-traumatic stress disorders (PTSD) for injuries on or after October 1, 2013. Since the exception went into place, employers have seen claims for so-called “mental-mental” claims increase, impacting their organization, their experience mod, and in some cases how they approach exposure to certain issues in the workplace. Moreover, with the outbreak of the coronavirus, some of these front-line workers are not only at risk for exposure (see here for more on state work comp claims around the virus) but may also be impacted from a mental health standpoint.
Minnesota workers’ compensation claims involving psychological/mental incidents are divided into three categories:
Minnesota only recognizes workers’ compensation claims based upon the first two categories but denies compensation for claims where mental stimulus results in a mental injury. However, in 2013, Minnesota’s Workers’ Compensation Act was amended to include a provision allowing for compensability of PTSD claims under certain circumstances for injuries on or after October 1, 2013.
Physical/mental: Cases in which work-related physical injury or trauma causes, aggravates, accelerates, or precipitates mental injury are compensated.
Mental/physical: A two-step test is necessary to prove causation for stress-induced injury. The claim must prove elements of both legal and medical causation to prevail with type of claim. To satisfy the medical requirement, the employee must prove the mental injury resulted in a physical injury. To satisfy the legal requirement, the employee must prove the stress was extreme or beyond ordinary day-to-day stress.
Mental/mental: For injuries occurring on or after Oct. 1, 2013, Minnesota Statutes section 176.011, subdivisions 15 and 16, were amended to include PTSD as a compensable workers’ compensation injury if it arises out of and in the course of employment.
For PTSD to be compensable it must:
PTSD is not considered a personal injury — and therefore not compensable — if it results from a disciplinary action, work evaluation, job transfer, layoff, demotion, promotion, termination, retirement or similar action taken in good faith by the employer.
According to Liberty Mutual Insurance 2018 claim data, more than 50% of injured workers become depressed in the first month of treatment which can extend the duration and cost of the claim. This can have a significant impact on your experience modification rating and a direct impact on your workers’ compensation premium:
The medical-only claim will have far less of an impact on your experience modification rating, while the lost-time claim will increase the experience modification rating and ultimately your insurance premium.
How does the experience modification rating (mod) impact your work comp premium? The mod represents either a credit or debit that's applied to your premium. A mod of 1.0 is the industry average. A mod over 1.0 is a debit mod, which means your losses are worse than expected and a surcharge will be added to your premium. A mod under 1.0 is a credit mod, which means your losses are better than expected and your premium will be lower.
Helping employees return to work quickly and safely following a workplace incident or injury can greatly impact the overall cost of a claim and reduce the impact to your mod. See our previous article on creative return to work strategies.
To prevent or reduce the severity of traumatic events, employers can leverage employee benefits and health management approaches.
Regardless of industry and risk for exposure to trauma, a culture that has de-stigmatized mental health conditions and offers an open and supportive environment to process traumatic events is an initial, less resource-intensive, non-program option to pursue. Nationally, non-first responder industry employers are adding more mental health benefits and resources. According to the Substance Abuse and Mental Health Services Administration division of the U.S. Department of Health and Human Services, there are different modifiable risk factors to minimizing trauma in first responders, including an organized and prepared operation of services can reduce the non-modifiable stressors of responding.
A common employee benefit that employees can use to be connected to more formal counseling, and sometimes formal de-briefing from crisis events, is the employee assistance program (EAP). Employers can opt to include more counseling sessions for a more conservative approach. Between the EAP or health insurance benefit, members should have easy and sufficient access to counseling visits.
The health insurance benefit is another way to offer more intensive behavioral health support to members. It is important to confirm that network and allowed benefits are accessible and include counseling services; it is common that networks do not have many providers that are geographically nearby and/or have timely appointments available. When there is poor accessibility in the design of this benefit, members may give up on treatment and/or end up paying for services out of pocket which leaves needs unmet or unsatisfying. Online or phone counseling is quickly becoming a solution to overcome the present limitations of the mental health care delivery system. Some employers, including rural clients, are making lists of providers who are specialized in the treatment of PTSD so that the barrier to finding a provider is removed.
Beyond maximizing and enhancing common employee benefits, health management and/or including wellness programs can bolster the health and resilience of employees and health plan members. It deserves a re-reminder that people who consume a nutritious diet, sleep, exercise and healthy relationships are overall healthier, more competent at their work and able to respond to demands of the job and daily life. However, working odd hours and helping others as a first responder can take focus away from these self-care activities that protect health. A common saying among different care professionals is “you need to take care of yourself in order to be able to take care of others.” Although there can be a genetic component, diseases like hypertension, diabetes and high cholesterol generally result from a lifestyle that lacks the aforementioned health factors. Mental health is also impacted by physical health. Having a culture and resources to maintain and improve health can support self-care.
Beyond supporting physical resilience, mental health as well as the general resilience of the mind is a globally protective attribute. Resilience can be trained and increased with programs that include mindfulness and/or some sort of cognitive behavioral therapy (CBT). Multiple mobile applications have recently been developed and deployed (sometimes included as part of the healthcare benefit) through health insurance carriers. These programs are a great option for members because they can be used on one’s own time and in privacy. Some clients have also deployed chaplain services and/or organized peer support programs. Leveraging community support or voluntary faith-based resources is another way for first responders to be supported in their service work.
Heather offers practical guidance and helps employers find solutions to employment law and compliance matters.
Heather educates and advises employers on all aspects of employment law, including compliance with state and federal laws, leaves of absence, discrimination, harassment, accommodations, discipline and discharge, wage and hour obligations, unfair competition, and other issues that arise in the workplace. In addition to Heather’s employment counseling, her background includes nearly a decade of litigation experience. Her prior experience includes litigating for a regional insurance company, business disputes, and employment.
Risk management and human resources are traditionally two different job functions, and the people in these areas have rarely crossed paths — but that is changing.
Why are these people starting to work together more frequently?
In its 2014 Workplace Safety Index, Liberty Mutual estimated that employers pay just under $1 billion per week to injured employees and their medical care providers. Since even one serious workplace injury may impact the bottom line of a small or mid-size business, it is essential that employers have an effective injury and illness prevention program in place.
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