Synopsis: Great Godfrey!! There Has to Be a Limit–One Shooting Results in More Than 450 PTSD Claims!!

 

Editor’s comment: Six city workers were physically injured but more than 450 city workers have filed workers’ compensation claims for PTSD following a mass shooting at Virginia Beach city offices in May 2019 that left 12 dead.

This shocking number of new and difficult-to-manage PTSD claims demonstrates to me how challenging PTSD claims may be for anyone to control. Please also note my view that this phenomenon is going to spike and spiral the cost of work comp coverage for post-traumatic stress claims.

In my view, one concern with PTSD claims comes as a consequence of how U.S. federal, state and local government employees work… they work to some extent as a “unit.” Across the country, legislatures are seeking “presumptive” coverage of PTSD for what are called “first responders.” As I have reported in the past, in an emergency someone has to handle/manage injured folks and also deal with or properly remove dead bodies. What some gov’t workers who can be called “first responders” seemingly want is to do the tough jobs they were hired to do, but then file PTSD claims and get paid by taxpayers for the rest of their lives. As fast as things get easier for “first responders” to get WC benefits, liberals across the country want to expand “first responders” to “any-responders.”

The current Virginia Beach mayor joins with all workers to claim the trauma extends beyond those who witnessed the incident firsthand. Mayor Dyer is quoted to say “A great many more were traumatized, including city employees, family members, chaplains, first responders and people who deliver emergency medical services by ambulance, by helicopter.”

What is happening is the City of Virginia Beach will quickly blow through their primary insurance layer and their skyrocketing number of new WC claims will move to the excess carrier. Sleepy Virginia Beach may now have the highest WC costs for any city in Virginia history! Trust me, that is going to mean dramatically increased excess insurance costs, particularly for municipalities around the country.

The History of PTSD

Called PTSD or “post-traumatic stress disorder” since the Viet Nam War, this condition had a long and interesting history. This stress syndrome has been called many things in the 150 years since it was first recognized as a psychiatric condition but every definition had several characteristics in common, including re-experiencing events, numbing feelings and physiological arousal. The process of Darwinian “natural selection” supported the evolution of people with highly developed stress responses; those pre-historic people with the most effective “fight or flight” reflexes became our ancestors. Curiously, during the 19th Century, what is known today as PTSD was called “Railway Spine” and was associated with what we would today call “hysterical” physical symptoms – i.e. “anxiety” expressed as bodily complaints – seen in people who had been involved in railway accidents but who suffered no bodily injuries.

My Focus for the WC Defense Industry Across the U.S.

Please remember my background and training is defense but there is no getting around PTSD in many situations—it is how to deal with the problem, not whether we can and should deal with it. Even the strongest defense view still needs to leave room for someone (or two) who might be shocked by a truly striking event.

 

That said, I assure you many municipal/government workers (in particular) are poised to try to take advantage of the PTSD concept to get paid and full benefits not to work. If we are going to be looking at many hundreds of workers for each unfortunate occurrence, we may have a PTSD “epidemic.” Please note a lifetime PTSD claim for most IL government workers could cost literally tens of millions of dollars. There is a lot at stake in reining in this phenomenon.

 

As you read this, I am betting Illinois government union officials will have secret/quiet/online “instructional guides” on how to maximize PTSD claims.

 

Again, my PTSD psych concerns are to

 

  • Ensure the diagnosis for PTSD is scientifically founded—serious and shocking we understand but we can’t have literally hundreds of such claims for every rapid and transient government occurrence.

  • Make treatment for PTSD have a beginning, middle and end to get the worker to MMI and then

  • Evaluate “permanency” or impairment from the event.

 

Great Experts for PTSD Claims in Illinois

 

It is important to locate IME experts/consultants who understand concerns about care and evaluation of PTSD claimants in the workers’ comp arena. Here is my vote for two:

 

Dr. Mark Mosk – Based in Highland Park, IL

 

After more than 30 years as a practicing forensic and clinical psychologist serving the worker’s compensation community, he has evaluated and treated hundreds of patients referred for suspected PTSD. Dr. Mosk confirms this is a complex type of stress related condition that presents with many different variations such that no two patients’ presenting symptoms, functional impacts, causes, and courses of treatment are alike. This is because two individuals never perceive an allegedly traumatic event in the same way, nor do they harbor the same preexisting coping skills to modulate their cognitive, emotional and physiological reactions to the purported trauma. Thus, the nature and possible causes of the alleged disorder, as well any necessary intervention tactics, are unique to each claim.

 

In his experience, a key to mitigating both the adverse clinical impact on a patient suffering from PTSD and to minimize the risk associated with managing a PTSD claim is to ensure the claimant undergoes a comprehensive evaluation as soon as possible following the actual traumatic exposure. Delay of this process greatly increases the likelihood the clinical condition will intensify and require more robust intervention. Similarly, Dr. Mosk found two proactive strategies for averting a mass traumatic event from evolving into multiple cases of PTSD to be particularly helpful. The first is to provide employees with advance preparation training to self-manage should such an event occur, and the second is to provide  onsite social support and cognitive behavior therapy based counseling immediately following exposure to a workplace trauma, which can help workers develop resilience to deal with the cognitive, psychological and physical symptoms often associated with such exposure. Dr. Mosk’s website with contact information is www.drmosk.com

 

Dr. Nausheen Din – Based in Barrington and Chicago

 

Dr. Nausheen Din, MD is a physician specializing in psychiatry. She is committed to assessing and treating patients with complex psychiatric and behavioral disorders including PTSD, depression, suicidality, bipolar disorder, OCD, generalized anxiety, social phobia, substance abuse, eating disorders, ADHD/ADD and autism. Treatment modalities offered include consultation, risk assessment, psychotropic medication management, individual and group psychotherapy, psychological testing and rTMS therapy. Dr. Din has been in private practice for close to fifteen years and maintains a multisystemic outlook in treating patients. She emphasizes the importance of a bio-psychosocial formulation, so that the treatment plan attends to all facets including psychiatric pathology, educational, athletic, interpersonal, social, familial and concurrent medical illness. If you want contact information, send me a reply, please.

 

If you have any other recommended PTSD experts in central and southern Illinois, send the contact information. I appreciate your thoughts and comments. Please post them on our award-winning blog.

 

 

Synopsis: EOB’s for IL WC Medical Care Are Coming At the IL WC Industry.

The Illinois Workers’ Compensation Commission is reminding all participants it has proposed a new rule that specifies how an IL WC insurer must send a complete explanation when work comp medical bills are denied.

The new proposed rule, required by the new law in Senate Bill 904, adopted in 2018, was published in the Illinois Register in September, and is available at this link: EOB Proposed Rule.

The rules, when enacted, will require all IL WC insurers or self-injured employers to send a form EOB or explanation of benefits that contains

  • Claim adjustment reason codes;

  • Remittance advice remark codes;

  • Reject codes from the National Council for Prescription Drug Programs; and

  • “All information necessary to match the explanation of benefits with the associated medical bill.”

Employers, payers and health care providers may exchange data for medical bills and explanation of benefits in a nonprescribed format by mutual agreement, the new proposed Rule says.

This is a seminal change in IL WC claims handling. I assure you it is happening and you won’t be able to avoid it. If you need help with implementation, send me a reply. I will continue to monitor and report progress.

I appreciate your thoughts and comments. Please post them on our award-winning blog.

 

The Basics of Workers’ Compensation – What’s Changed for Illinois

 

January 21, 2020 | 10:30 am – 12:00 pm | Webinar

Join Shawn Biery from Keefe, Campbell, Biery & Associates for a webinar which will cover the basics of workers’ compensation claims in IL. You will learn the ins and outs of managing workplace injury claims, litigated or not. From investigation to setting claim targets, to closing claims efficiently, this 90 minute webinar will guide your business toward favorable outcomes from every workers’ compensation claim. We will also highlight some of the recent trends and current potential changes to the system so you won’t want to miss out on your chance to get ahead of the pack.

 

Register Here