A 41-year-old forklift operator was loading a container at a loading dock when the truck pulled away and his forklift began to fall between the container and the dock. As the forklift fell, his hand became caught between the forklift and the dock plate. As a result, his hand was severed above the wrist. The employee underwent a successful seven-hour replantation procedure, but ultimately suffered from an infection and lost the hand. Not long after the injury, the employee reported nightmares and extreme anxiety and was professionally diagnosed with physical post-traumatic stress disorder (PTSD). Throughout the following year, his symptoms of anxiety and depression precluded his ability to attend medical appointments and he was unable to return to work.

This employee’s story is not rare. In fact, 6% to 32% of individuals exposed to a traumatic event will develop PTSD, according to the Journal of Public Health Policy. Chronic emotional stress claims due to a physical injury are on the rise.

What is PTSD? The term emerged in 1980 when it appeared in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. Today, the diagnosed medical condition is defined as “a disorder that develops in some people who have experienced a shocking, scary or dangerous event.” Symptoms can include:

• recurrent flashbacks or dreams of the event;
• emotional numbness;
• avoidance of stimuli; and
• a heightened state of alertness.

If not properly treated by a psychologist or psychiatrist, the individual may resort to coping mechanisms or other related disorders, such as depression, substance abuse and memory or cognition issues, among others.

All 50 states and the District of Columbia specifically address workers’ compensation compensability for mental-physical injuries either by statute, regulation or case law. However, it should be noted that mental-mental injuries not triggered by a physical injury are not recognized for workers’ compensation claims in certain states; and those states that do offer compensation benefits may only cover first-responders.

Companies faced with an employee emotional trauma claim are well served to understand what distinguishes PTSD from a similar condition called acute stress disorder. PTSD is a chronic condition that typically emerges as a delayed onset and does not abate with time. Acute stress disorder, in comparison, tends to appear shortly after a traumatic event and can be resolved over a short period of time. Not surprisingly, treatment costs involved with a valid PTSD claim are often significantly higher, extending for a longer duration than the treatment for acute stress disorder.

One can assume that anxiety about job security and lost wages play a role in emotional stress disorders after a catastrophic injury. It is devastating enough to lose a limb or suffer paralysis, but when the injury is work related, employees face additional emotionally-challenging thoughts:

• Will returning to work be possible?
• What job skills have been lost?
• Will it be possible to find suitable work again with permanent, physical restrictions?

For those employees able to return to their regular jobs, it can be difficult to resume working in the place where they suffered a life-changing injury.

Claims Management of a PTSD Diagnosis

An experienced workers’ compensation adjuster will know what to look for when such claims are filed; the first step being the need to assess the initial claim or physical injury. Was it truly a severe traumatic injury? Did the employee experience the injury directly or did he witness a traumatic work-related event? What is the treatment history for the injured worker? When did the emotional stress start? All parties should work together to understand the circumstances and quickly provide the employee with the proper care for the injuries, both physical and mental. Timely and ongoing communication is essential when dealing with this type of claim.

When PTSD is suspected, a workers’ compensation adjuster should recommend the injured worker see a psychiatrist or psychologist to determine a diagnosis. A diagnosis of PTSD states that an adult must have all of the following emotional symptoms for at least one month:

• one re-experiencing symptom;
• one avoidance symptom;
• two arousal and reactivity symptoms; and
• two cognition and mood symptoms.

A psychological Independent Medical Examination may be an option for a claims professional to consider if the diagnosis or treatment plan is questionable.

The injured employee may need to be treated for the mental/emotional claim beyond the duration of treatment for the physical injury. As with any medical treatment for a claim, psychiatric treatment would be monitored by the claims adjuster to assure the employee is on track for medical improvement. With the right protocols, an injured worker can return to work in the previous position for the same employer.

As a successful case study, consider the construction worker that suffered a severe head injury due to an on-site fall from a scaffold. Treatment for his physical injuries was a success and he was able to return to work. Several years later, however, he experienced extreme anxiety and depression as a result of the injury and submitted a workers’ compensation claim. The psychiatrist determined that the employee had work related injury PTSD and developed a psychiatric treatment plan. Over time, the employee learned tools he could use to cope with the trauma and continued to work in the same job with the same employer.

Timely Mental Health Care Crucial

Many employers and insurance professionals are seeing an increase in the number of physical injuries that ultimately result in PTSD. It is unclear if the prevalence of PTSD is truly rising, or if this trend is due to heightened awareness of PTSD as a legitimate medical condition as defined by diagnostic criteria. Whatever the reason, experts anticipate further increase in PTSD in the general working population.

There are definite medical effects of a PTSD workers’ compensation claim. Left untreated they can be costly and impede an employee’s recovery from the physical injuries the individual may have sustained due to the incident. Anxiety and depression can affect a person’s perception of pain and hinder compliance with the recommended medical treatment necessary for recovery. Additionally, persons with untreated or poorly treated psychological conditions are at a higher risk for other chronic medical conditions, which may indirectly impact an employee’s ability to return to work or their performance when working.

What can employers do to help mitigate the risk and cost of PTSD after a physical injury? It is crucial that injured employees with suspected PTSD or other emotional stress disorders are treated compassionately and provided with timely mental health care. Though restricting access to treatment may reduce immediate costs, employers can expect to be challenged by large increases in other costs, including absenteeism, future work-related injuries, long-term disability and potentially prolonged claimant litigation proceedings.

Demonstrating empathy and acknowledging the employee’s concerns can be vital to supporting the employee’s improvement. In addition to hearing from their adjuster, the injured employee wants to hear from the employer and be confident that they care. It is in everyone’s best interest to treat PTSD claims seriously and quickly take appropriate action.