Behavioral Health Issues Add Costs and Delay Injured Worker Recovery
Injured workers with identified behavioral health conditions experienced markedly longer return-to-work timelines and slower claims resolution compared to the average lost-time claim, according to an analysis by Sentry Insurance.
Sentry analyzed over 45,000 workers’ compensation claims from 2012-2019, focusing on key health conditions, including chronic pain, chronic pain with medication, and psychosocial factors. Based on the analysis, Sentry developed predictive analytics models, the Injured Employee Complexity Factor (IECF) Models™, to identify claims that would benefit from early intervention and support.
“The numbers make it clear that everyone involved can benefit by reimagining the conversation surrounding injured workers,” said Greg Larson, assistant VP of workers’ compensation claims at Sentry.
Psychological distress following an occupational injury can create barriers—such as anxiety, depression, catastrophic thinking, fear of reinjury or job loss, and lack of social support—that delay recovery and return to work, the study found. In cases where behavioral health conditions were present vs. the average lost-time claim, return to work was 2.6 times greater and claims duration was 1.8 time longer.
Although the number of behavioral health-referred claims is small, they account for a substantial percentage of overall costs.
IECF-flagged claims see a 5.6 times greater probability of exceeding $250,000 in claim costs and a 1.7 times greater likelihood of litigation than average lost time claims, Sentry reported.
Injured worker claims involving behavioral health characteristics were more likely to rely on opioids and have more medical care, according to the report. Injured workers with behavioral health conditions were 3.3 times more likely to be prescribed opioids, and had 1.6 times greater potential for multiple surgeries.
While opioids are necessary for pain relief in a variety of injury cases, they also carry a risk for dependence, misuse, and higher costs, Sentry noted.
Comorbidities and age factors also play a significant role in recovery. Nearly two-thirds of IECF-flagged claims involve comorbidities, such as arthritis, asthma, cardiac issues, diabetes, hypertension, obesity, psychological issues, smoking, and substance abuse. The proportion of behavioral health claims increases with age, especially for workers aged 41-64, implying the need for employer planning and early intervention with an aging workforce.
Injury types and their impact on behavioral health were also examined. Extended lost time is more likely with multiple injuries, shoulder, or lower back injuries, as they can affect day-to-day life at home, increasing psychosocial risks.
Among all lost-time claims, the most frequent body part involved was “other” in 29% of claims, followed by finger, hand, wrist or elbow, 18%, and ankle, foot or knee, 16%.
Among behavioral health-referred claims, the most common were “other,” at 26%, followed by multiple body parts, 20%, and shoulder, 17%.
The IECF Models identify workers who may benefit from early behavioral health interventions, such as managed care plans focused on physical and mental support, telephonic nurse case management, virtual reality therapy, counseling, pharmacy benefits, and weekly communication.
“Every injury tells a story beyond the physical harm. The findings in our data suggest that we also need to understand the well-being of injured workers. The earlier we can recognize an injured worker’s physical, emotional, and social hurdles, the sooner we can offer targeted, personal support to help them throughout their recovery,” stated Jean Feldman, RN, BSN, director of managed care at Sentry.
The report encourages employers to rethink their approach to claims and invest in behavioral health resources, while insurers should retrain staff on strategies for addressing behavioral health risks.
Article Published By: riskandinsurance.com
Article Written By: R&I Editorial Team
