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At the root of a mental disability claim, case managers often uncover workplace issues that have been unaddressed by the employee’s provider. By addressing the human resource issues that delay or prevent the employee’s return to work, the claim often can be resolved.
"Sometimes, the depression or nervous disorder is actually caused by a problem at work," notes Kenneth Millsap, BS, PTA, assistant vice president of loss containment for CIGNA Group Insur ance in Philadelphia. "The employer is often unaware of the issue. Treating physicians also often fail to address issues at work with the employee. So the employee stays out on disability, and the work issues preventing the employee’s return to full productivity are not resolved. It’s not just that the employee has a fear of returning to the workplace, but the human resource department often doesn’t want the employee back until he or she has been completely released by his or her psychiatrist," he adds.
CIGNA refers its unresolved mental disability cases to its sister company MCC Behavioral Care in Minneapolis. Psychiatric case managers interview employees to determine whether there are any personal or professional issues preventing their return to work, says Millsap. (See story on MCC’s case management approach, at right.)
He recalls the case of a 37-year-old woman who worked as a quality assurance specialist for a large manufacturing company. She was diagnosed with major depressive disorder and adjustment disorder and placed on disability. Her psychologist noted that her initial symptoms included an inability to think, sleep, or function in her usual activities. The employee reported feeling overwhelmed and unable to cope with major stresses in her personal life. The symptoms were still present three months later when the woman was under a psychiatrist’s care for medical management.
CIGNA referred the case to MCC six months after the disability onset. An MCC case manager contacted the woman and her psychiatrist. The woman told her MCC case manager that she was fully able to perform daily activities, enjoyed recreational activities, and was currently representing herself in a legal matter.
An MCC physician advisor reviewed her case and discovered when talking to her attending psychiatrist that a work site issue, not the claim ant’s medical status, was the major barrier to her returning to work. MCC found no evidence of disability and recommended the employer address the human resource issue that was affecting the woman’s motivation to return to work. The employer agreed, and the employee is currently back on the job.