Preventing fraud in the California workers’ compensation system is a high priority. When someone makes a fraudulent claim, it affects everyone because it takes money from the system that could go to a person who suffers a real work injury. There are many checks and balances within the system to help prevent fraud. However, sometimes, fraud prevention measures are actually hurting workers. This is the case with mental health evaluations.
Business Insurance reports that there is an increase in mental health evaluations, which the system often uses to verify that a mental health condition does exist. This could be detrimental to workers who have mental illness issues that qualify them for workers’ compensation. An evaluation ensures a claim is legitimate, and an increase in them sends the message that workers’ compensation does not cover mental health issues.
The reason why mental illness claims seem to come under review so often is that some workers use this type of illness to prolong the claim and continue to receive benefits after a physical injury heals. This leads to increases in overall costs.
Many claims may start as a physical issue and then later turn into a mental illness claim. When this happens, the system wants to verify the condition is real and not a way for someone to keep collecting benefits.
In the state
In California, though, there is not the same movement as in other parts of the country. From 2015 to 2018, there was not an increase in mental health evaluations. This shows that in this state, the system accepts claims for mental illness more often, and disputes do not occur at an irregular rate for this type of request.
This is good news because California often leads the way in trends for workers’ compensation. So, if others follow its lead, mental illness claims may no longer have the stigma of being a way to cheat the system.