A Primer on Behavioral Health Care in Workers’ Comp
Sep 1, 2022

A Reminder:

As we announced in our previous issue, the Gallagher Bassett Journal is going monthly, starting on September 15, 2022. Our format may change just a bit, but we will still be offering our insights on what’s happening in the world of risk management that may merit a moment of your attention. As always, we’ll strive to be brief, brisk and to the point while perhaps adding an occasional moment of levity, a glimpse of history, or a questionable pun to lighten a sometimes heavy topic.


A Primer on Behavioral Health Care in Workers’ Comp

Your humble correspondent segued from administering group health plans for migrant farm workers into building new workers comp plans back in the late 1980s. In those days we seldom, if ever, breathed a word about behavioral health matters in discussing comp. The conventional wisdom was “don’t buy a mental health claim—they never end.”*


My, how things have changed. The good people at the Workers’ Compensation Research Institute (WCRI) have just published what Joe Paduda calls “one of the most important papers WCRI has published in recent memory.” We agree with Joe’s assessment whole heartedly. The research paper, titled A Primer on Behavioral Health Care in Workers’ Compensation, is available free to WCRI members and at a modest fee for non-members. And, yes, you want to read it if comp is anywhere in your wheelhouse.


This is a large, wide-reaching report—complete and meticulous, as we expect from WCRI. It deserves to be read in detail, but here are a few highlights:

  • What do we mean by “behavioral health” in the context of comp?
  • Why is this important in managing comp claims? What happens if behavioral health issues are not addressed? Is it just another co-morbid like hypertension and obesity or does it work differently?
  • How do we surface underlying behavioral health issues while managing a comp claim? What do we mean by psychosocial factors and how might this crop up in a claim review?
  • What is the association between behavioral health issues and claimant clinical compliance and/or normal RTW?
  • What treatment modalities are available that fit well in the context of managing a comp claim?
  • How do you find a mental health professional who understands the special needs of comp?
  • Most of all, how does recognizing and addressing mental health co-morbidities impact claim outcomes?

We suspect that reading this report will lead you to want to talk to your claims TPA about how you want behavioral health issues handled. Should this be included in your special account instructions, for example?


As you read the WCRI report, think about what it’s like to be an injured employee with a serious claim. You’re hurting, your whole routine of daily life is upside down, your role as a provider for your family is in jeopardy, your support base of your friends at work is no longer close. Most of us are very poor at playing the role of invalid. It gets on our nerves after a day or two. You are under a whole new array of stresses and pressures and there is probably no one at home who understands what you’re going through. Is it possible that you might need help from someone who does understand?


WCRI says, “This study helps to identify behavioral health issues in workers’ compensation and create a common language and understanding.” Sounds good to us. Time to leave the old regime of “look the other way” on the trash heap of history.


*Back then, we still had the old law on “stress claims” in California and that served as the bad example showing why you didn’t touch mental health if you could avoid it. That’s ancient history today.

Does it seem that way to you too?

Say What?

It’s a common enough question—what are the most important skills for a risk manager, especially for a new risk manager? The ongoing flurry of retirements as the Boomers make their exit from the daily grind means, among other things, that a good many folks are moving up to take the helm of risk programs or of important risk components. So, readers ask me—what’s the one skill I need to focus on to be optimally effective handling big risk units? Do I need more technical training—a black belt in Excel perhaps? Should I have an engineering credential? Or a refresher in insurance law?


A recent issue of workerscompensation.com carried a neat little essay that helps us answer exactly this question—“May I Have Your Attention Please - Are You Listening?”. Yeah—the most important superpower for a risk manager is the ability to listen, to really connect with what colleagues, bosses, clients, brokers, and all those other folks are saying. The author, Justin Banks, puts it neatly: “Half of all communication is listening. The best listener not only remembers what was said, but engages in the conversation throughout.”


Mr. Banks talks about listening in the context of managing safety programs, but his points apply to all aspects of the risk enterprise—pay attention, engage, don’t interrupt, reserve judgment, and practice mindful listening. Ask questions if you don’t quite “get” something. When I was an operations consultant, I used to tell my new clients that all the expertise they needed to optimize their operations was already present—in the people who worked there every day. My job was to ask questions and listen to the answers and then organize that information in new, compact, and useful ways*.


Humans are visually oriented but scanning reports and SOPs can tell you only what the person who created that report or SOP thought was important back when they wrote it. A good conversation flows, takes you to new places and ideas, opens up new possibilities. Want to be really good at what you do? Get really good at asking questions and then listening to the answers.


Remember: the greatest mistake we commonly make about communication is assuming that it has happened. Active listening, leaning into the conversation, is the fundamental skill for working with people. This little essay can help you become more mindful about your ears. They do far more than hold your glasses on your head.


*I was paid quite well for listening intently, most often to people who were delighted to share what they knew and have it valued.



Quick Take 1:
Whither The Weather, Part 2

Some events make a lasting impression. One such occasion for your correspondent was being in the middle of a howling rain squall on I-84 on my motorcycle. According to my weather app, there was no storm, so I didn’t have a problem. After that experience, we look just a bit skeptically here in late August at a number of articles popping up in the press with titles like “Quiet hurricane season? Not for long, Tampa Bay meteorologists say”.


The various forecasting organizations all agreed last spring that we were looking at a heavier than normal hurricane season. While there is certainly plenty of weather going on this year, thus far it hasn’t included much in the way of tropical activity. Droughts, heat waves, monsoons—yes. Hurricanes—no. We could still get sucker-punched, of course, but we are normally right in the heart of the hurricane parade this time of year.


We mention this because those of us in the risk management business have to be more aware than most of the limits of our ability to forecast events. We gave a presentation a couple of years ago at the Risk Institute at Ohio State titled “Why is It So Hard to Predict the Future?”* We have so many troves of big data, so many modeling tools at our fingertips that we think the future should be surrendering more of its mysteries to our constant interrogation.


But reality remains a hard nut to crack. Our understanding of the underlying mechanisms of both nature and our own man-made social economies is more limited than we want to admit. Bottom line, this is exactly why insurance is a long way from being obsolete. The good news and the bad news are the same—life retains its ability to surprise and amaze us every day. Like it surprised me, standing on the side of I-84 muttering to my phone while cold rain dripped off my helmet.


*Copies on request, if you’re interested.


Quick Take 2:
What Gives?

It took me many years to understand what my Swedish grandfather meant when he said to me, a little tow-headed kid trying to figure stuff out, “When you grow up, you’ll see that all roads are toll roads.” This Journal has been following the stats on highway accidents and deaths since we started seven years ago. For a long time, the rate of highway deaths per million miles driven kept edging down. Vehicles kept getting safer with new collision-avoidance technology, better materials and designs, even improvements in road construction. Until 2015 all was well.

The graphic from NHTSA makes the point. Remember, we are talking about fatalities here, no fender-benders included. What’s going on in your fleet operations? We all know that experienced professional drivers are retiring in large numbers. Could that be a factor? The accommodations we all made for the pandemic certainly rearranged a lot of fleet operations, another possible cause. Other data in the press tell us that traffic seems to be moving faster for reasons which are not entirely clear.


We mention all this simply as a reminder that there is no time when we can back off or coast on driver training, truck maintenance and fleet safety measures. The NHTSA numbers make it clear that the need for vigilance keeps edging up nowadays. Meanwhile the driverless trucks and delivery drones we’ve been promised are still not quite ready for prime time. You might want to pester your claims people for their latest analytics to profile your fleet claims trends and bother your broker* for the latest in transportation loss consulting and talk over any changes in your exposure profiles. These stats remind us that it’s not just about dollars. Indeed, the tolls are going up in lives as well.


*You won’t really bother them, of course. Expert brokers and claims teams are eager to show you what they can do to improve program performance. Just ask.


PS: This is the time of year when deer and other woodland animals start thinking about…, well, each other. It’s mating season. Remind your drivers that it’s time for extra vigilance, especially in the morning and evening.


Say It Isn't So...

The economics of working from home may be changing. The cost of electricity is rising rapidly in the UK. One analysis calls for the cost per kilowatt hour to go up by 65% relative to just a couple of years ago. Indeed, an average British household may soon be paying some £3,244 ($3833 USD) annually for power.


Some observers are asking whether this may be enough to scuttle the work from home movement as a British winter sets in and heat becomes a luxury good for many. The heat and lights back in the old office may look good again. If so, watch for aspects of the employment risk pendulum to swing back to pre-pandemic values.


Other European economies may be heading in the same direction. Could the US be in that line one of these days? A lot of factors are in play. Stay tuned.


Words To Remember

September: If you can read the opening from “Try to Remember” and not hear the music, recall who you were with when you first heard it, well, you are either very young or you haven’t been paying enough attention.


Try to remember the kind of September
When life was slow and oh, so mellow.
Try to remember the kind of September
When grass was green and grain was yellow.
Try to remember the kind of September
When you were a tender and callow fellow.
Try to remember, and if you remember,
Then follow.


The Fantasticks, 1960, Schmidt and Jones


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