In recent years, the number of mental illness diagnoses in the United States has been steadily increasing. The National Institute for Mental Health (NIMH) has observed a significant rise in the number of adults affected by mental illness over the past decade, with an even greater increase as a result of the COVID-19 pandemic. Reports from NIMH indicate that nearly 60 million Americans, or one in five adults, are currently living with a mental illness.
The increase in the number of mental health conditions has led to a growing demand for comprehensive disability claims management. Many, if not most, disabilities impact a claimant’s mental health due to a loss of function, a loss of identity, or the challenge of facing an uncertain future. These factors, when combined with the possible loss of income, are stressful and difficult to handle, especially when combined with a serious medical condition.
The nuanced nature of disability claims with a co-morbid condition poses a considerable challenge to insurers, especially as the industry grapples with losing seasoned claim professionals due to retirement and burnout. Co-morbid claims are particularly challenging given the mental health condition may be undiagnosed due to the treating provider being unaware. In other cases, the claimant may not be aware or in denial that they have a mental health condition. In these situations, the claimant is likely not receiving treatment.
Successfully managing mental health claims requires a strategic and multifaceted approach leveraging a combination of specialized expertise, ongoing training, and access to resources to effectively navigate challenges that may arise during the recovery and return-to-work process.
Encourage Open Conversations
Disability claim analysts receive specialized training to recognize the signs of someone struggling with recovery. In some situations, claimants may be dealing with what is known as a “disability mindset,” which refers to challenges seemingly unrelated to their diagnosed conditions. Others may struggle to reenter a work environment that feels stressful or overwhelming. Conversations with claimants are key to uncovering the real and perceived barriers to recovery and return-to-work.
Due to the nuances involved, it is essential to approach conversations with claimants having a sense of curiosity about what might be affecting them and their recovery, particularly when they are dealing with a mental health condition. Asking relevant questions and practicing active listening can provide further insight into claimants as individuals and what support they might need.
For example, consider if a claimant shares having an increased level of anxiety around the possibility of returning to a previous place of employment. Upon further questioning, it could become clear that there is a difficult relationship with a peer, leading them to feel unsupported. The mere thought of returning to this environment could be exacerbating the condition, even if only subconsciously. Distinguishing between a situational impairment and a global impairment is an important part of managing these co-morbid claims.
Encouraging an open dialogue with claimants will not only help to support the management of the claim, but it can go a long way in helping to destigmatize internal feelings of embarrassment about mental illness. Men often struggle to talk openly, feeling shame in admitting to symptoms of depression or anxiety. Demonstrating empathy toward claimants about their circumstances can pave the way for future meaningful conversations, leading to better outcomes in the long run.
Invest in Coaching and Mentoring Opportunities
Managing claims with a mental health diagnosis requires specific skills developed through specialized training and on-the-job experience. Seasoned claims adjustors should have a certain level of awareness, allowing them to pick up on cues that may indicate a possible underlying mental health issue that is not part of the claim but could be impacting recovery.
Experienced claim managers can recognize signs of claims where a mental health condition may adversely impact the claimant, whereas a claims manager with less experience may not. For example, a claimant could be on the way to recovery and return to work after being out because of a seizure disorder when suddenly progress stalls. Detailed questioning by the seasoned claim manager uncovers that the claimant may be struggling with an undiagnosed case of depression, which is hindering recovery and making it more challenging to transition back to the workforce.
Providing one-on-one coaching or mentorship opportunities can be a valuable training tool for claims teams looking to enhance their on-the-job skills and knowledge. Ongoing coaching can improve awareness and bolster the confidence needed for effective claimant interviews. Opportunities for newer team members to observe senior claim professionals during calls, especially those related to mental health claims, can be instrumental in teaching valuable skills and encouraging ongoing professional growth and development.
Seek Expert Guidance
To properly manage a mental health claim, a comprehensive range of medical evidence, including medical records, doctor’s notes and test results, must be obtained and thoroughly reviewed to make informed decisions. If the claimant is treating with one or more mental health professionals, then obtaining and reviewing those records is necessary. Analyzing the evidence can be challenging if it isn’t clear what to look for, so deploying resources with a deep understanding of the factors relevant to the claimant’s condition may be necessary.
Leveraging external resources, such as clinical partners, consulting physicians or nurse practitioners can help claims teams better navigate the complexities associated with a claim associated with a mental health condition. Consultants who provide independent reviews can help improve the accuracy and thoroughness of adjudicating these complex claims.
Expert medical guidance is important, yet not all claimants will be in treatment with a mental health provider, especially if the treating provider is not aware of the underlying mental health struggles. In some cases, it is possible for the claim specialist to have a better perspective on a claimant’s level of mental health functioning than his or her treating provider.
Provide Recovery and Return-to-Work Support
Because of the nuances involved in condition treatment and management, there is no one straight path to follow when managing mental health claims. If typical treatment does not improve the claimant’s condition, further efforts may be required to ensure the claimant receives appropriate medical support and treatment.
A claimant who is only treating anxiety through medication managed by a primary care physician might need additional support if symptoms have not improved. In this instance, a claim manager may recommend that the claimant speak to the primary care physician about a referral to a psychiatrist or treating prescriber to see if that can increase the odds of recovery.
Developing a sufficient return-to-work plan for mental health claimants is also important. With a doctor’s approval and continued monitoring, a partial return with workplace accommodations is typically the ideal starting point. Helping a claimant obtain and implement any necessary accommodations is not only important from a compliance perspective, but can also be a vital step toward a successful return-to-work outcome.
The motivation of the claimant is the foundation of a successful return-to-work. An experienced Claim Specialist can assess a claimant’s level of motivation and provide encouragement and support.
Employers can also play an integral role in supporting claimants in their reentry to the workforce. In a recent interview with Forbes, Dr. Joel Axler, National Behavior Health Leader at Brown & Brown, shared that employers should consider “implementing awareness programs to train managers to recognize signs of stress and burnout, such as changes in behavior, productivity or attendance and to respond appropriately and sensitively.” When employers foster this type of environment, claimants may have a better chance of a more effective return-to-work outcome.
Brown & Brown Absence Services Group has the seasoned resources available and ready to assist with disability claim management, including mental health claims. Our team at Brown & Brown can provide guidance and support to help build a thriving claim organization. Reach out to us today to get started!
