April 25, 2025
Kimberly George, Global Chief Brand Officer at Sedgwick, is joined by Max Koonce, Chief Claims Officer. They discussed the prevalence of mental health claims, inspired by a commentary paper that Max and his team released titled Unveiling the Hidden Struggles: Mental Health and Workers’ Compensation.
Here are some highlights from their talk:
The rise of mental health visibility in workers’ comp.
Mental health has been part of the disability and accommodations space for years — particularly on the non-occupational side.
- In the years since COVID, mental health claims and care have been on the rise.
- Mental health concerns have taken a more prominent space in state legislatures, especially for first responders.
- Its presence in the workers’ compensation landscape is gaining even more traction, with societal attention and evolving legislation prompting the industry to take a closer look.
- Employers are encouraging more mental health and wellbeing treatments with digital health apps, telehealth appointments, access to behavioral specialists and more.
Mental health claims and state-by-state differences.
Mental health claims currently make up a small portion of overall workers’ compensation cases—less than 2%. With every state having its own legislation, many workers don’t know what kind of mental health claims are available to them and what is covered.
- Koonce describes two types of claims in the mental health space:
- “Mental-mental”: mental health claims that don’t involve a physical injury.
- “Physical-mental”: mental health claims that arise out of a physical injury that’s covered by worker’s compensation.
- Every state has different burdens of proof for what is allowed for each type of claim with little consistency.
- Most states still only allow mental health-related claims when tied to a physical injury (“physical-mental”).
- Data shows a slightly higher prevalence of “mental-mental” health claims than those tied to a physical injury.
- Prevalence is strongly influenced by state legislation, with an increase in claim volume in states that permit “mental-mental” claim filings.
Early intervention means better outcomes.
One of the most important findings in this paper is that early behavioral health treatment leads to significantly better results.
- Intervention from a behavioral health specialist within the first 90 days of a claim reduced claim time by 60–70% — and led to more successful return-to-work outcomes.
- Claims with delayed mental health treatment often lasted more than three times longer than those without mental health components.
- Treating mental health like any other comorbidity can lead to better recovery timelines and overall experiences for injured workers.
Overall, a holistic, case-by-case approach is preferred. Not every case is assigned a mental health worker and state laws vary, but they’re powerful tools to get better outcomes for workers.
Re-visit the paper, Unveiling the Hidden Struggles: Mental Health and Workers’ Compensation, here.
And listen to the whole conversation between George and Koonce here.
