Understand psychosocial issues to mitigate chronic pain claims

Workers' comp participants often roll their eyes at the mention of psychosocial issues affecting a claim. "Here's yet one more person who's claiming they are depressed about their job, their pain, whatever," said Mark Walls, assistant vice president for St. Louis-based Safety National. "Because of this there's always been this tendency to ignore these issues, to resist them."

But resisting the so-called psychosocial issues in a claim can be counterproductive. Stakeholders are finding that nonphysical aspects can turn seemingly simple claims into complex, long-term, expensive propositions.

"More and more people are recognizing that by addressing those issues head-on rather than ignoring them you can keep control of the claim and keep it heading in the right direction and not lose control of the situation," Walls said.

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One of the areas where workers' comp stakeholders are seeing the effects of psychosocial issues on claims concerns chronic pain that can result when physical ailments are exacerbated by emotional issues. "There is a huge psychosocial issue to chronic pain," Walls said. "That's why two people with the same injury don't respond the same. Those psychosocial issues are enormous."

Effectively addressing the psychosocial issues in a workers' comp claim involves two aspects. "Number one is how to identify these psychosocial issues," Walls said. "Number two is what to do when you see them. Those are two areas the workers' comp community very much needs education in."

The three panelists in the session will examine psychosocial issues and their impact on workers' comp claims from two different perspectives. One speaker is a clinician who will discuss the issue from a treatment standpoint and how to identify and treat the issues. The other two represent a third-party administrator and a self-insured employer.

"They are coming at it from the proactive approach of trying to early on identify these claims that have these risk factors and trying to employ your interventions early in the claim," Walls said. "It's that process of looking for that potential problem, rather than waiting for something to blow up in your face and wondering why it happened."

Recognizing which claimants have psychosocial issues that could turn their claims into more complex scenarios is no easy task. Employers are just beginning to develop strategies.

"The profiling that Broadspire and BJC [Healthcare] are doing to actively try to identify these claims is very innovative, but it's the type of thing where, if they have success with it, you'll see the industry jump on board with it," Walls said. "That's one of the things I hope to see."

For example, Walls said BJC Healthcare sends injured claimants to specific physicians based on psychosocial factors. "If they have a concern, they'll make sure the treating physician is equipped to treat those issues," he said.

Read more at the WorkersComp Forum homepage.

October 31, 2011

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