Is Mental Injury Out of Sight, Out of Mind?

03.20.2017


By: Robert Wilson 

Yesterday Peter Rousmaniere published a rather scathing opinion piece on this site accusing the insurance industry in general of intentionally misleading the federal government and others when it comes to mental injury claims. It was his position that workers’ compensation insurers are shirking their responsibilities in the area of mental health, and of being intentionally deceptive regarding the matter. While I personally agree that we are not meeting acceptable standards regarding certain mental injury situations, I am not as ready as he to lay the blame solely at the doorstep of the insurance industry.

I rather believe it to be a much broader societal problem. In our culture we have trouble recognizing and empathizing with many mental health injuries, occupational or otherwise.

In my view, insurance companies are merely conduits through which services are rendered and costs are passed on. In the final analysis, it doesn’t matter what insurers are “required” to cover or how much they spend; in very few scenarios are those costs not passed on to the employers and clients they serve. Regarding coverages for mental health issues, I suspect you will find as much or more resistance in the ranks of the employers those insurance companies serve. To that extent insurers may just be representing the interests of their customers, to whom they have certain financial obligations. While that doesn’t change the outcome of Rousmaniere’s observations, it means that we have to dig much deeper to truly address this problem.

Employer resistance to mental health issues is not just evident when applied to specific mental injury claims. Many of them avoid any reference to psych or mental issues as if the words themselves were a plague. To that end, the majority still refuse to address psycho social issues that are derailing active physical injury claims, simply because they “don’t want to pay for psych”.

Yet they pay for it every stinking day. 

The bias against mental illnesses can be seen in many places. Some minority groups have strong taboo’s against seeking help for anything of a mental nature. Private LTD plans often give short shrift to mental assistance benefits. General Health insurance almost always has very limited benefits for these types of ailments. When Rousmaniere and I discussed this, he said he heard that was because no one really wants or thinks they will need that coverage. If correct, it points to a broad, consumer based bias against mental health issues. Call it the “never happen to me” syndrome, if you will.

Many of us are guilty of at times “poo-pooing” mental health issues. I know I am culpable of such; we just do not give as much credence to injuries and issues we cannot see, and mental issues are often in the sweet spot of invisibility. Clearly the concept of so called “mental-mental” is fraught with potential abuse. The same “cloak of invisibility” can easily facilitate malingering and fraud for that category. This should not, however, prohibit us from acknowledging and helping those who have experienced significant trauma. We need to, as a collective nation, help erase the stigma that envelopes mental health concerns.

Peter’s column brings up an excellent point, however. When discussing mental trauma within the context of specific terrorist events, he asserts that the true damage that ISIS and other terror organizations wish to inflict is mental stress and injury; that damaging us emotionally is far more valuable than the taking of a few lives and limbs. He calls this mix the Terrorist Cocktail. It was within this context that he felt the industry intentionally misled the feds when appealing for the continuation of TRIA, the Terrorism Risk Insurance Act. He argued that the industry made the case for backstop coverage while not being honest about our mental case exclusions. However, as I indicated, insurance simply passes costs along. I am not sure the industry reps he mentions would have motivation to intentionally mislead. After all, the backstop coverage they sought would eliminate their risks for the conditions they currently exclude, so I am not sure I see the financial benefit of intentional deceit. It is far more likely in my mind that this was a case of “out of sight, out of mind” (Pun not intended).

While the issue of PTSD and other mental disorders in workers’ comp seems to be focused on the realm of the first responder, the issue certainly has broader ramifications for everyone in society. Certainly it is not unreasonable to expect a First Responder to experience issues from seeing a partner shot, or responding to a school where dozens of young children have been slaughtered by a mad man. Are private sector incidents any less traumatic? Do we have an ethical obligation to an employee who witnesses co-workers murdered during a company lunch or on the factory floor? Is it not, in the end, a compassionate viewpoint that assistance be made available to people in those situations?

And how is that type of occupational trauma less debilitating than a physical on the job injury?

The old adage, “before you judge a man, walk a mile in his shoes”, may truly apply here. It is just, as a society, we have no way of doing that. We have to develop empathy in other ways to overcome this obstacle. For persons truly damaged in this capacity, the “suck it up buttercup” treatment protocol is just not going to cut it.

Undoubtedly the insurance companies have some ownership of this problem, but it is not theirs and theirs alone. We need to look in the mirror and recognize the depth of the acceptance deficit. Until we do, all I am afraid we will accomplish on the matter is useless finger pointing. 

And that will most assuredly drive us all crazy.

The foregoing was originally published on Bob's Cluttered Desk Blog and is reproduced here with permission of the author. No further republication is permitted without the author’s consent.


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