Tuesday, March 11, 2014

Mom's Working and Happy

Generally accepted psychological principal is that working is good for the head and that is why there is such an emphasis on return to work in the workers' compensation context.

Work is a huge part of one's identity.

According to a 2012 study by Abay Asfaw, Ph.D., and Kerry Souza, Ph.D., of the Centers for Disease Control and Prevention, injured workers are 45% more likely to be treated for depression than non-injured workers.

That makes some sense to me, particularly after seeing my father go through his life, essentially "working" all the way up to the end, albeit as a volunteer. Nevertheless, his identity was hugely connected to the Oceanside Police Department where he felt particular swagger in his role as administrator of the department's gang unit database.

I see this in my mother, whom we have relocated to a beautiful memory care facility. Mom has advanced dementia, but she still likes to "work"; her dementia has sharpened her obsessive/compulsive qualities and she can't help but clean up after others. She's put to good use at her new facility and I can tell it brings her joy because she has purpose in life!

And that explains one of her diagnosis of "depression" upon discharge from the last rehabilitation facility - she didn't have anything to there!

Mom getting ready to "work".

So at least in my mind there is a deep connection between work, work injury and mental health.

Some states recognize this and other states don't.

A recent case in Ohio recognizes that it is settled law in that state that a worker's suicide is compensable as long as it is "causally related" to the worker's injury; there has to be "some effect upon the mind" from the injury, because of an injury to the head or because the injury is causing chronic pain, or because it led to the development of a psychological condition, causing the worker to become depressed.

The worker in that case committed suicide 5 days before Christmas, a particularly troubling time for many people regardless of work status. Her estranged husband sought, and obtained, death benefits before it was discovered that he didn't live with her and was charged with committing fraud. The case eventually settled, and what led to the court opinion is that the husband didn't get what he thought he was going to get out of the settlement.

Be that as it may, not all states provide workers' compensation benefits for the survivors of workers who have committed suicide. Illinois, Pennsylvania, Massachusetts and Washington will provide for awards if the worker's suicide had a causal link to the employment or industrial injury, but in other states, suicide is treated as a break in the causal chain.

Earlier this year, the Montana Supreme Court denied a request to decide if, under the 2007 Workers' Compensation Act, a death from suicide is an intentional act and an independent intervening cause that breaks the chain of causation between an industrial injury and the death. The court said it saw no reason to exercise its ability to bring the dispute out of the Workers' Compensation Court, since there was no indication that the normal appeal process would be inadequate for whichever party is aggrieved by the WCC decision.

Florida's workers' compensation statute states compensation is not payable if the injury was "occasioned primarily...by the willful intention of the employee to injure or kill himself, herself or another."

Alabama's comp scheme contains a similar limitation, as does the Longshore and Harbor Workers' Compensation Act. But the Benefits Review Board has recognized an exception when the suicide attempt results from an "irresistible impulse" caused by a work-related injury.

Courts in New York, Nevada and North Carolina will also award benefits for a suicide if the worker was driven to kill herself because of a mental depression and derangement directly related to and caused by her compensable injury.

The point to all of this is that there is wide disparity in the legal recognition of the importance of work to mental health - perhaps as many reasons as there are people making those claims. It is very difficult for claims administrators to ferret out legitimate claims for mental injury arising out of a work place situation.

I have argued before, and I maintain my position, that workers' compensation is not about return to work. RTW is a tool in the workers' compensation administrator's box, but it is not the end goal of the system. It might be the end goal of a worker, or claims payer, but not of the system itself.

And my guess is that there are as many different view points about the efficacy of providing mental health benefits as a part of any workers' compensation treatment scheme. Clearly this is exemplified by the different state's treatment of suicide arising out of a work injury.

I can say one thing after watching my parents go through their senior years - work IS important. How one defines "work" depends upon the circumstances, the individuals involved, the production required.

Whether one is paid in some remunerative fashion or simply gains personal satisfaction from doing a job, most people enjoy feeling productive, which is why there is such a high depression rate among those who get hurt on the job.

I'm keeping Mom working for as long as she wants...

1 comment:

  1. Thank you for all of your great topics but this one I enjoyed reading more. Appreciate the insight.