Defending Psychological Workers’ Compensation Claims in North Carolina: Part 4 of 4
This is the fourth and final article in a four-part series discussing different aspects of workers’ compensation psychological claims in North Carolina, including:
- Part 1: Psychological Claims Resulting from Physical Injury;
- Part 2: Non-Physical Injury by Accident Psychological Claims;
- Part 3: Non-Physical Occupational Disease Psychological Claims; and
- Part 4: Claims Handling Tips for Psychological Workers’ Compensation Claims.
Claims Handling Tips for Psychological Workers’ Compensation Claims
As we discussed in this series, the burden of proof for a psychological workers’ compensation claim lies with the plaintiff. However, to prepare a proper defense, there are some key claims handling tips to take into account, which include:
- Ensure a thorough recorded statement is taken as soon as notification of a claim is received. The recorded statement should:
- Address the plaintiff’s regular, normal job duties;
- Identify anything new or unusual with the plaintiff’s job and the length of time or duration of the new or unusual activity;
- Identify the plaintiff’s prior medical history including whether he or she has ever treated for depression, anxiety, or any other psychological illness. If so, pin down the exact illness diagnosed; the type and frequency of psychiatric treatment received before and after; any difference in the plaintiff’s complaints or intensity level with regards to his psychological illness; and, the name of the medical professional providing treatment;
- Always request the contact information for the plaintiff’s primary care physician so you can obtain the records before accepting the claim;
- Identify the plaintiff’s supervisor and the co-workers plaintiff interacted with on a daily basis (so that interviews and fact investigation can occur with these individuals); and,
- Identify the plaintiff’s hobbies and activities (if plaintiff is going to baseball games and/or concerts on a regular basis then it is unlikely that he or she has an inability to function in society or at work).
- Conduct surveillance, if warranted, to investigate the plaintiff’s physical activities and demeanor outside of his treating relationship with medical providers.
- Perform extensive employer interviews in the early stages of the case. These interviews should also involve the plaintiff’s co-workers so that any pre-existing problems or complaints can be identified as compared to the new complaints that may have arisen.
- Retain a psychological professional to analyze the issues, the type of job the plaintiff performs, and elicit opinions on causation.
- Enroll the plaintiff in counseling instead of simply approving medications for psychological or mental illnesses. A plaintiff’s depression may drastically improve with counseling on a regular basis. Treatment notes often provide helpful information for the claim as well.
- Control the claim by directing the plaintiff’s medical care. Make sure that only an approved, treating physician provides medications instead of allowing the plaintiff to go to his primary care physician for additional care for the same condition.
By engaging in these best practices early, during the investigative phase of the claim, a stronger defense can be prepared against psychological workers’ compensation claims when litigation does ensue.