Reintegrating an employee who has experienced a compensable mental injury into the workplace is a complex process that requires the same treatment, communication and claims management strategies used for all workers compensation cases, with one main difference: subjectivity.
Mental injuries lack the objectivity of physical injuries, requiring employers, claims handlers and providers to better understand what part of the work caused the mental condition and to focus on helping the injured worker reach maximum medical improvement, according to experts.
Although still a small portion of workers comp claims, coverage for mental injuries continues to be a legislative trend (see related story below). In parallel, experts say mental health diagnoses in workers comp are increasing, especially where there is also a physical injury, as the stigma around mental health problems diminishes.
Driven by policy changes, the comp industry is managing diagnoses such as post-traumatic stress disorder, anxiety and depression. The disorders are defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which is often cited in state laws permitting mental claims in workers comp.
States like Alaska, New York and Wisconsin have a broader definition and include “stress” in their workers comp laws, allowing claims for mental conditions caused by a stressor deemed “extraordinary.”
The complexity could confuse an industry that’s more used to fixing broken bones.
The concept of apportionment is important for workers comp, said Dr. Les Kertay, Chattanooga, Tennessee-based chief medical officer at Ascellus, a behavioral health provider for injured workers.
Employers and workers comp insurers used to avoid so-called psych injuries because of the subjectivity, he said. Now the problem may have reversed, with broad treatment through the comp system of every mental ailment affecting an injured worker, and a notion that a mentally unwell person can’t return to work.
Dr. Kertay said his job is “not to make them perfect, which, as a therapist, I really want to do; I want to make you as good as you can possibly be. But my job is really to help you get back to the place where you can function.”
Claims examiners need to understand that mental injuries are treatable and that injured workers can return to work and that “it’s going to ultimately be better for them if they can go back to work,” he said.
The challenge for claims organizations and employers is: How can a worker return to a job or a place that caused the condition?
“There’s an information gap that a lot of employers have about what is considered a treatable mental health condition and what is outside of that,” said Mark Debus, Chicago-based clinical manager of behavioral health at Sedgwick.
The condition must be diagnosed correctly at the outset, said Dr. Ron Heredia, a psychologist and the director and founder of Los Angeles-based Good Mood Legal, which provides medical-legal consulting. An early misstep can inhibit return to work, he said.
A correct diagnosis determines the specific treatment plan needed to address the psychological condition, he said, adding that “what follows is a treatment process to address that specific psychological disorder.”
That treatment schedule is somewhat flexible, he added.
Karen Thomas, Culpeper, Virginia-based vice president of clinical solutions for CorVel, warns against a one-size-fits-all approach to managing a mental claim.
“Humans are complicated,” she said. “Not acknowledging individual differences is really going to undermine the success of recovery, of return to work.”
There are benchmarks for mental injuries, just as there are for physical injuries that assess factors like mobility and movement, but measuring them can be complex and more nuanced, Mr. Debus said.
Professionals treating mental injuries should have experience in workers comp and focus their treatment on trauma recovery, he said, adding that it could be a challenge, given the shortage of professionals in the sector.
The industry can help by educating providers on return-to-work protocols, said Tammy Bradly, Birmingham, Alabama-based senior director of clinical product marketing at Enlyte Group. For physical injuries, many medical providers are familiar with terms like job analyses, work restrictions and accommodations — and many can be applied to mental injuries, she said.
For example, a job analysis provided to a treating psychologist can outline the essential functions of the job and the mental demands, she said. A thorough analysis “can go a long way in having appropriate return-to-work planning.”
Accommodations can include a different work setup or classification, flexible schedules or more frequent breaks, she said.
Early intervention also is key, said Jennifer Cogbill, Frisco, Texas-based senior vice president of GB Care with Gallagher Bassett. “We have to understand that when somebody has these types of injuries, we need to draw on the expertise to help them recover, and we have those resources available,” she said.
Expansion laws lose momentum
States continue to consider proposals to broaden acceptance of mental injuries in workers compensation, though recent results have been mixed compared with legislation in more than a dozen states in the past five years that expanded mental health conditions as compensable.
In a review of workers compensation-related legislation considered through mid-2025, The National Council on Compensation Insurance in September ranked mental injuries as the top issue. That reflects a years-long trend of expanding acceptance of mental injuries in workers comp, according to similar analyses released by the ratings agency.
According to the NCCI’s most recent legislative report, seven states — Hawaii, Illinois, Kentucky, Montana, New York, South Carolina and Texas — considered legislation this year to establish or amend coverage for post-traumatic stress disorder and/or other psychological injuries for certain first responders. Most failed to gain traction or were rejected as of October.
Bills expanding benefits to other worker classifications failed in two states: North Dakota considered legislation for PTSD coverage for all employees, and legislation in Kentucky would have broadened the definition of injury “to include a psychological, psychiatric, or stress-related change that is not a direct result of a physical injury” and added a rebuttable presumption for PTSD for educators. Similar bills in California and Washington are pending.
Nevada and Tennessee expanded mental injury presumptions for first responders.
Connecticut, which two years ago expanded mental injury coverage to all workers who witnessed a qualifying event, such as a death, considered legislation to extend coverage to include witnessing an injury “not resulting in death or loss of a vital body part or function as a qualifying event for post-traumatic stress injuries.” Two measures in the state, one applying only to first responders, failed to gain traction, according to the NCCI.
This article was first published in Business Insurance
