Psychiatric services coverage for injured workers

If your patients are workers with psychiatric or psychological conditions, they may be eligible for specialist coverage. WorkSafeBC provides assessment and treatment for workers suffering from such conditions if they are associated with one of the following:
•    A compensable consequence of a work-related physical injury.
•    A reaction to one or more traumatic events arising out of and in the course of employment.
•    The predominant outcome of a significant work-related stressor, including bullying and harassment, or the result of a cumulative series of work-related stressors arising out of and in the course of employment.

What family physicians should do
If you wish to provide a psychiatric referral for a patient with an apparent work-related psychiatric or psychological condition, you should follow your usual practice. This includes treating and possibly referring your patient to a community mental health program, private psychiatrist, or other mental health professional. You should also encourage your patient to report his or her injury to WorkSafeBC by contacting Teleclaim at 1 888 WORKERS and sending in a detailed Form 8/11 Physician’s Report.

Psychiatric conditions typically have multifactorial etiology that may require significant investigations and assessments to establish causation and coverage eligibility. While this analysis is underway, WorkSafeBC does not cover workers’ medical or psychiatric treatment, and defers to the family physician to proceed with the required treatment. In certain circumstances, WorkSafeBC may provide time-limited psychological support.

Once WorkSafeBC accepts a claim for a psychiatric or psychological disorder, a medical advisor will work with you to arrange psychiatric referrals for your patient, as needed. WorkSafeBC will also consider treatment by a psychologist or a multidisciplinary program as an alternative or complementary intervention.

You are encouraged to access local private psychiatrists or appropriate mental health teams directly, and to copy WorkSafeBC on your referral letters. Please ask private psychiatrists to use the expedited fee code 19911, providing they’ve seen the worker and given the initial report to WorkSafeBC within 15 business days from the date of referral.

How WorkSafeBC can help
When a worker with an accepted claim is unable to gain timely access to a local psychiatrist, a WorkSafeBC medical advisor can arrange a psychiatric referral in consultation with you, as the family physician. The medical advisor will write the referral on your behalf to one of the community-based psychiatrists in the WorkSafeBC External Psychiatric Provider network. You will receive a copy of the letter and remain primarily responsible for your patient.

Typically, these psychiatric providers will see workers within 6 weeks, but the patient may be required to travel. After the consultation, the psychiatrist’s report will be addressed directly to you, with a copy to WorkSafeBC. Your patient may also receive follow-up care, if required, although this may prove challenging in cases where the patient lives in a rural or remote community. When consultations require your patient to travel significantly, he or she may consider the initial psychiatric consultation an interim measure before gaining access to a local community psychiatric service.

Access to emergency services
It’s important to note that you remain responsible for the care of your patients while awaiting psychiatric consultations. WorkSafeBC does not have special access to hospital or psychiatric inpatient facilities, or the ability to deal with psychiatric emergencies or urgent referrals. In these circumstances, you are advised to use community resources as you would for any patient without a WorkSafeBC claim. 

For more information
If you require further information or assistance regarding a worker’s psychiatric condition, contact a medical advisor in your local WorkSafeBC office or make the request on your Form 8/11. To connect with the appropriate medical advisor, call WorkSafeBC Medical Services at 1 855 476-3049. 
—Harry Karlinsky MD, MSc, FRCPC

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This article is the opinion of WorkSafeBC and has not been peer reviewed by the BCMJ Editorial Board.