Managing Behavioral Health Disability Claims

Jai Hooker@Work


Managing Behavioral Health Disability Claims

By Phil Lacy, ADL Absence Health and Productivity Practice Leader, Marsh McLennan Agency

Anxiety disorders affect more than 40 million adults in the U.S.1 Generalized anxiety disorder (GAD), a mental health condition, affects 6.8 million adults annually2 and is a common cause of workplace disability and unemployment.3

GAD symptoms — which include irritability or edginess, rapid heart rate and breathing, fatigue, concentration problems, sleep disturbances, and gastrointestinal problems — can be subjective, which can make it difficult for absence and disability managers to manage leaves.

Anyone can experience feelings of anxiety at different times. But when these feelings lead to ongoing distress and impair daily functionality, employees can miss work.

The percentage of short-term disability (STD) claims for behavioral health conditions in the Mental and Nervous Disorders diagnostic category nearly doubled from 2000 to 2021.4,5 And mental health issues, including depression and anxiety, are among the top five reasons for STD claims.5

Knowledge Is Power

Absence and disability managers must validate the severity of employee symptoms that justifies time away from work for treatment and recovery, which can be difficult. Good case management requires specialized training and tools for this type of assessment. For example, learning how to determine severity of mental health symptoms can help these managers make a disability determination, and learning how to work with a primary care provider when an employee is not being seen by a psychiatrist or psychologist can help absence management teams work more effectively with employees.

Employers must also ensure that they engage and communicate with employees who are experiencing GAD and depression. These actions can improve outcomes and return-to-work time frames. Below are a few areas of vulnerability identified during behavioral health claim audits2 for anxiety and depression:

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