Attitudes and myths concerning mental illness create an image of the mentally ill worker as someone who has a weak character, has no will power, is violent and can never recover. The misconception that medications and work don’t mix adds to the problem. With a sound treatment plan and effective case management of the behavioral issues, the injured worker can often be quickly returned to work as a productive employee.

When these attitudes and myths about mental illness are combined with the complex issues of claims management, second and independent appeals and regulations governing ADA and EEOC, even the most experienced case manager is faced with the difficult task of balancing the legal rights and W/C benefits of the employee with the responsibilities of the insurers and the company’s need for a successful return to work program.

Size and Scope of the Problem
50% of patients with a major depression treated by a non psychiatrist will remain depressed after 1 year. The diagnosis and detection of behavioral disorders is missed in 33 to 50% of primary care outpatient cases.
Stephen P. Melek, Milliman & Robinson June 2000 Broker World

Medical Surgical Costs per Case
In 1980 medical surgical costs per case were $1,746, in 1990 the cost escalated to $6,611, and by the year 2000 it reached $10,000 per case.
2002 The Journal of Occupational and Environmental Medicine

Disability Cases as a percent of Cost of Claims
In 2000 medical costs were 75 to 88% of all worker compensation claims. Psychiatric costs represented 12 to 25% of all claims. However psychiatric cases are 2 to 3 times more costly than medical cases. i.e. $20,000 – $30,000 per psychiatric case vs $10,000 per medical case.

There are a number of reasons why psychiatric cases are more expensive than medical cases; the complexities of diagnosis, difficulties in medication management, particularly in pain management cases, multiple psychological and psychiatric evaluations, the cost of second opinions and the expense of litigation.

Chicken or Egg?
When faced with a claim, the case manager is often presented with the question, “is the employee’s condition a medical or behavioral problem or both”? How this question is answered will determine the effectiveness of the return to work process.

The following is a check list of the types of cases involving medical and behavioral issues for which we can provide services:

• Any case that has been open for six months or longer with a poor prognosis for recovery.
• Cases that were originally medical, that now have psychiatric claims, such as depression, anxiety, panic or post traumatic stress disorder.
• Cases that were originally medical, that now require in-patient psychiatric or substance abuse treatment.
• Litigation cases – when there is a need for an medical opinion of the injured worker’s psychiatric or psychological diagnosis or treatment or a question of ability or willingness to return to work.

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