Quick, now: When was the last time you heard about a workers' compensation case? Well, of course it's been a long while, you may reply; those cases just aren't sexy enough, or compelling enough (translation: not profitable enough). And all those people are just lazy anyway. So, while we are diverted to all consuming efforts to save that prisoner from execution by illustrating he did love his sister (and not in an unseemly way), and while we toil away investigating whether Sheila was traumatized by her boss' drunken comments at the Christmas party, we forget thousands of plaintiffs in workers compensation litigation who may be a lot more like us than we care to admit. The mental health needs of this population are too often dismissed, and consequently, so is the effort to reclaim them as worthwhile contributors to our society.
The daily third worldliness in the halls outside the workers compensation courtroom is surpassed only by what goes on inside. A pervasive lack of sophistication and a punitive approach to psychiatric illness is commonplace. The result: a system where patient, doctor, and court work with separate and distinct agendas, each quite ignorant of the others'.
Psychiatry must promote workers reclamation.
Doctors already shy away from treating comp; they are sure to have to fight to get paid, with no guarantees they ever will. Delays in gaining approval for psychiatric treatment for a work-related injury may extend for years. The doctor in effect becomes a plaintiff herself, going to court knowing that if she does not dramatically portray the patient's symptoms, she may be stuck with an unpaid bill for two to three years of services rendered. Unless the doctor is Mother Theresa, the billing dilemma will inevitably interfere with the treatment alliance. Furthermore, it may pressure treating therapists to testify with the bias of a hired gun. Is that really what the court wants when it asks the doctor about the degree of the patient's disability, and the likelihood of improvement?
The cookie cutter world of workers' comp also features the consultant retained by the insurance company, who never consults the treating physician, and makes no attempt to obtain corroborating information. Yet, he is empowered to predictably offer under oath, "Yes, your honor, he was mugged and tortured on the job, both of his legs were broken, his eye was knocked out, he is wheelchair bound, and I acknowledge that he is depressed, but in my professional opinion, that is because the Dallas Cowboys are out of the playoffs."
And the judge doesn't bat an eye.
The comp cases languish on; repeatedly adjourned and appealed, and we wake up years later knowing that much less about the case and with still no resolution. These are not criminals, but they have no due process. They are not beating their kids, but what is the best interest of their children? Their work history does not necessarily suggest they are eager to join the ranks of the disabled, but should they be tied up into their hearing so long they become unemployable? They are not escaping into bankruptcy court having raped their creditors, so should we expedite their financial collapse by denying them a prompt financial resolution?
Ruling on psychological injury is all about understanding the impact of an event on the person, searching for confounding stresses, and determining degree of disability and prognosis. Therapeutic emphasis is about engaging the person who gets sick in her treatment, and on focusing the plaintiff who is exaggerating on getting on with her life. Psychiatry has a responsibility to promote not just workers' compensation, but workers' reclamation. And the courts should be prioritizing this as well.
The workers' compensation field sorely needs an infusion of vision to upgrade the psychological sophistication of the process. This starts with a more thoughtful and critically thinking court. It needs a fast track mechanism, along with incentives for recovery, made available to patients viewed as temporarily disabled. These measures can only be effected by recasting the workers' compensation courts from their current design as mere battlegrounds over public assistance to a more constructive role as protector of middle class workers.
Public interest attorneys should be more visible in this area of the law, which requires family, civil rights, and mental health sensitivity. Doctors should be expected to offer a confirmed, reliable history. And payment for services must be guaranteed so those with work-related ailments will have access to quality therapists who patch them up aggressively to return to the workplace.
