Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Termination of Care

Termination of Care“Termination of Care“

Under workers’ compensation, care is terminated for reasons that markedly differ from terminating a private patient. To some extent, this is similar to termination in orthopedic or neurological care. However, there are some significant differences which point to the flaws in the workers’ compensation system.

Referral for psychological care has always been delayed. The primary physician may not note, and/or the patient may not report symptoms that indicate the need for psychological care. Additionally, the primary physician may elect not to become involved in this decision since it falls outside his specialty. He may simply take the position that `I am here to address the physical injury, and someone else needs to determine if there are indications for psychological care.’

When the referral is finally made, there is a secondary delay in awaiting authorization and the involvement of many (often excluding the patient) in this decision process.

After the patient is seen for initial evaluation, there is a tertiary delay while many of the same individuals are involved in accepting the diagnostic findings and approving care, along with setting limits on the length and frequency of care.

Let us assume that ultimately the patient is seen for a combination of pain and depression. (The other most common reason for referral is for posttraumatic stress disorder and addiction). The patient may, as in the case of orthopedic care, be seen until s/he reaches maximum medical improvement. At that point, there is no indication for continued care, and the patient is released. The patient may not be symptom free, but it has been determined that further improvement is not forthcoming at this time. The patient, thereby, may have a permanent and partial psychological disability.

There are cases in which care is ended that are less than ideal: a. Care is ended by a third party for financial reasons b. Care is ended by the patient who is threatened by aspects of the direction of care c. Care is ended abruptly because the patient’s workers’ compensation claim “settles.”

Of greatest concern is the latter. A claim is often settled because a patient has reached orthopedic MMI. This may not coincide with the patient reaching psychological MMI. This lack of correspondence between emotional recovery and physical recovery is quite problematic. The patient is expected to re-enter life and the workforce without professional support, to manage the numerous and difficult challenges that will now arise.

This same patient seen privately would remain in care until problems are resolved or (b) occurs. Since this is the nature of the “system,” it is crucial that the patient have sufficient lead time to prepare for what is often a problematic future.

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