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Managing Mental Health claims

“At least 20% of Australia’s workforce suffers from mental health issues, but not all make it to the claim stage,” says ASX-listed private sector rehabilitation provider Konekt Ltd’s Market Report. Konekt formed its opinion after analysing more than 95,000 compensable cases referred to it over the past five years. Workplace-related injuries cost the economy an estimated $60.6bn each year or 4.8% of GDP, the report said. However, the economic cost “could be mitigated” if workers received early intervention (treatment/rehab) after suffering physical or psychological injuries – “plus they will likely experience greater health and return-to-work (RTW) outcomes”. The report concluded Australian organisations “are dragging the chain” on rehab.

According to the report, most analysed injuries were musculoskeletal (60%) and 12% of all referrals to Konekt over the past five years were for psychological injuries. The report found “the direct and indirect workers’ compensation costs associated with psychological injury claims significantly exceed the costs associated with non-psychological injury claims”.

Konekt believed current and future actuarial and premium assumptions did “not yet adequately anticipate this change in injury profile and cost”. Additionally, it was “likely we will see an acute shortage of skilled staff to manage these cases by 2017”.

The rehab provider analysed 95,470 referrals taken from its case management database. The referrals were opened from July 1, 2008, to June 26, 2013. Of the 95,470 referrals, 74,395 (78%) were referrals related to cases in the workers’ compensation system (compensable referrals) and 21,075 (22%) were referrals from employers (non-compensable referrals). Of those referred, 77% were for specific services such as functional assessments, daily living assessment activities, worksite assessments. Twenty-three per cent were for RTW support and assistance. Closed cases represented 95% of the data analysed, and only those cases were used when analysing outcomes, Konekt said.

The report found a worker who was off work for 20 days had a 70% “chance of ever returning to work”. At 45 days they had a 50% chance; and at 70 days their RTW chance dropped to 35%. Konekt said the average age of a worker being referred for rehab services was 41, with 51% of all referrals for people aged 30-49 years; the rate of compensable referrals that did not result in RTW was 12%, double that for non-compensable referrals at 6%. On average, there was an 84% RTW for mental health injuries, compared with 89% for other injuries. “Those with lower socioeconomic profiles had a significantly longer average delay to referral time [102 weeks] compared to those with the higher socioeconomic profiles [84 weeks],” the report said.

Konekt’s head of product Matt May said “one of the key findings of this report is the earlier a referral is made post-injury, the greater the likelihood of a successful RTW”. May said the report “clearly demonstrates the considerable opportunity” the non-compensable data presented. “Overall, the non-compensable cases outperformed the compensable cases on all criteria, including RTW rates, cost and duration of the claim[s].” May said “policymakers and regulators need to be looking more closely at this as a best-practice model for the compensable market”. But despite the benefits of early intervention, Konekt found over the past year there had been an increase in the average time from incident/injury to referral for support and RTW services of 90 weeks. “This is really alarming,” May said. “Compare workplace injur[ies] to sporting injuries – if a professional sportsperson is injured the help they receive is immediate. So why can’t it be the same for workers?” May said it had been proven “working improves general health and wellbeing and reduces psychological distress” for most individuals.

Source: Thomson Reuters Workers Compensation Report 950

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