Sound claim handling and decision-making requires a good understanding of the presenting problems and the dynamics involved. Grespi recognises that mental health-related claims may be associated with vague or limited information about the underlying condition (particularly when GP notes refer to ‘stress’ or ‘anxiety and depression’), difficulty in evaluating treatment to date and motivation, and in some case conflict in the relationship between claimant and insurer. In addition, insurers are faced with a myriad of potential mental health professionals and types of assessment. There is a high risk of duplicate assessments which may not answer the key questions, or the creation of stuck situations. Grespi therefore places the highest priority on the triage, assessment and diagnosis of presenting problems.
The triage and assessment process takes place at the outset of any assignment, and ensures that as claim assessor you remain in the driving seat of the process. We start with a phone conversation with one of our senior consultants. A typical conversation will take about 20 minutes, and allows for the problem to be clarified and an initial understanding to be formed. This allows you to have clarity on your overall approach for managing the problem and for the key questions for a report to be identified.
The triage call may be followed as appropriate by a face-to-face assessment consultation with the claimant and a report that includes a diagnostic formulation of the problem(s), a rational opinion on fitness for work and return-to-work prospects, and recommendations as to any action required.
Effective triage means that the right pathway is identified early, and the right processes are followed.
To arrange a triage conversation within three hours, click here.
Psychiatric IME (independent medical examination)
In cases where insurers and the Grespi senior consultant agree that an IME should be provided, it is usual practice for Grespi to expect a written instruction (usually via email) in which insurers indicate questions and queries which the Grespi assessor is expected to address and clarify in the IME report.
IME reports are detailed medico-legal documents, often 20-30 pages long, which are required for cases of particular clinical complexity; differing views on diagnosis; tortuous employment-related dynamics; and/or high potential for litigation.
The IME consultation can take place either at a Grespi consulting room; as a home visit at the claimant’s address; at an ad hoc rented office near the claimant’s home address; or via Skype.
IME consultations are carried out with the claimant’s written consent. We also review relevant medical records. Following the consultation and records review, we share our IME report with the claimant to allow for a factual accuracy check and to ensure that informed consent is obtained to release the report. This step is in keeping with the General Medical Council (GMC) Good Medical Practice guidelines, and also ensures that your claim handling remains on sound medico-legal footing.
Standard Grespi IME reports cover:
As a first step, we recommend a triage telephone conversation.
Other specialist assessment
When claim assessors and a Grespi senior consultant may agree that a full psychiatric independent medical examination (IME) is not required, other assessment options may be considered and agreed.
General psychiatric assessment
The general psychiatric assessment differs from the psychiatric IME essentially because clinical reports, normally five-to-seven pages long, go less into medico-legal detail, yet also cover diagnosis, prognosis, fitness for work, return-to-work prospects, questions regarding disability and reasonable adjustments and treatment recommendations.
Clinical psychology assessment
We also provide specialist clinical psychology assessments, for example where psychometric testing is required.
Occupational therapy in mental health assessment
Grespi can also provide occupational therapy assessments, particularly in those cases where return to work or alternative work plans may need to be developed; or when the expertise of an occupational therapist in mental health is required to mediate between claimant and employer when relationships may be difficult or conflictual.
In the first instance, we recommend an insurance triage phone call for clarification of the remit.
Clinical file review
In some cases, a claim or an individual’s situation becomes stuck despite multiple specialist assessments and reports, or repeated attempts at treatment. This may be particularly relevant where there are differing clinical views expressed in reports by experts, or where there is a lack of clarity regarding treatments recommended, treatments offered and the response to treatments that have actually been carried through. Legal disputes, dysfunctional dynamics or uncertainty about motivation may add to the complexity. Grespi offers a review of clinical files held by insurers for the purpose of providing an overview, an evaluation of the strengths and weaknesses of different sources of information, and a clinical opinion on the best way forward.
Telephone consultation service for claims assessors
Grespi offers a telephone/Skype consultation service for complex insurance-related situations. These typically involve discussions between a Grespi consultant and claims assessor on the management of particularly challenging claims, dysfunctional dynamics or organisational issues. Consultations of 60 to 90 minutes are made available within 48 hours.
In cases where an initial IME consultation or general psychiatric assessment with one of our specialists has identified a mental health condition, our consultant psychiatrists can provide pharmacological treatment combined with a psychological approach, as well as follow-up consultations to monitor treatment and progress, as appropriate.
An initial IME consultation may identify the need for clinical psychology. Clinical psychologists use a psychological formulation (or way of understanding difficulties) to address symptoms and suffering or promote personal development. They may use a range of psychotherapeutic techniques and support in order to help the individual put themselves on firmer psychological footing and work towards achieving personal goals. Where there is a specific need, they may also carry out psychometric testing. Grespi psychologists are accredited with the Health and Care Professions Council (HCPC) and are skilled in working in tandem with our psychiatrists and other mental health clinicians.
Occupational therapy in mental health
An initial IME consultation may lead to a recommendation for occupational therapy. Occupational therapists (OTs) in mental health help individuals to optimise their engagement in meaningful and productive roles in their employment and, more in general, in any occupational setting. The individual is helped to identify their goals, translate these into realistic objectives and to stay on task in working towards these objectives within an agreed timeframe. Such help is particularly important for people who may need to make a significant recalibration in their lives or reintegrate in work following a period of illness or, in some cases, consider whether a redirection in their employment status and context may be a healthier prospect for them. Grespi OTs are registered with the Health and Care Professions Council (HCPC) and are skilled in working in tandem with our psychiatrists and other mental health clinicians.
An initial IME consultation may identify a need for psychotherapy. This is form of talking treatment, which is mindful of the individual’s strengths and which seeks to link the individual’s difficulties in the present situation with their origins in childhood and subsequent life experiences. By using the treatment relationship with the psychotherapist to understand and resolve these difficulties, the individual can move from a somewhat stuck psychological position into a freer one, and apply their strengths to more adaptive ways of dealing with problems and relationships. This also includes becoming better able to build on their psychological potential in a working environment and become better equipped to work pressures. Grespi’s psychotherapists are registered with the main umbrella organisations for psychotherapy in the UK – the British Psychoanalytic Council (BPC), the UK Council for Psychotherapy (UKCP) and the British Association for Counselling and Psychotherapy (BACP). They are skilled in working in tandem with our psychiatrists and other mental health clinicians.
Cognitive behavioural therapy (CBT)
An initial IME consultation may identify a need for cognitive-behavioural therapy. CBT is a type of talking treatment that helps the individual identify their typical ways of thinking and behaving, and link this with their feelings and symptoms. By strengthening helpful thoughts strategies, while challenging unhelpful ones, the individual and their therapist work towards goals by setting exercises which the individual then carries out in a supported way. Grespi’s CBT therapists are registered with the British Association for Behavioural-Cognitive Psychotherapy (BABCP), the main accreditation body for CBT in the UK, and are skilled in working in tandem with our psychiatrists.
An initial IME consultation may lead to a course of counselling. Counselling aims at helping individuals to broaden their awareness of their psychological difficulties, and how these affect their everyday life. It is however important to differentiate counselling from psychotherapy, in that psychotherapy aims at fostering significant psychological changes and help individuals settle on a healthier and permanent mental health plateau. It should also be noted that EAPs typically offer ‘generic counselling’ as a general opportunity to ‘talk things through’. On the other hand, counsellors with NHS experience and additional training in occupational mental health are better placed to provide effective help to employees experiencing psychological difficulties also in relation to their employment role and duties. All Grespi counsellors have accumulated years of NHS experience and obtained additional training in occupational mental health. They hold registrations with the professional bodies for counselling and psychotherapy in the UK, such as the BACP, the BPC and the UKCP. Grespi counsellors are skilled in working in parallel with our psychiatrists and other mental health clinicians.
Individuals who have developed severe or chronic mental health difficulties and/or have been on sick leave for long periods may require well thought-out, planned and structured support to return to work and remain in work. This can be a complex process involving the careful evaluation of the claimant’s psychological strengths and weaknesses, an appropriate degree of support and guidance aimed at enhancing the claimant’s potential for independence; and a productive dialogue with the employer regarding the return to work process and time framework, as well as in some cases appropriate reasonable adjustments in the workplace and an evaluation of progress. At Grespi we recognise that a ‘one size fits all’ approach is unlikely to be effective, and emphasise the need to adopt a ‘case-by-case’ approach via the expertise of specialist occupational therapists in mental health. As a first step, we recommend an IME assessment consultation to clarify the individual case.
In some cases, the relationship between the claimant and their employer has become woven into the insurance claimant’s psychological difficulties in such a way that a stuck situation develops. The claimant may be fearful of returning to work to the extent that a return to work is not immediately realistic. Alternatively, a grievance may have developed or conflicts may have erupted between claimant and employer. At the same time, the lack of movement regarding a return to work may be contributing to the maintenance of the individual’s psychological difficulties and interfere with recovery.
Grespi recognises that an independent and neutral third party who understands the psychological dynamics involved may be needed in order to help unblock the situation. Grespi occupational therapists in mental health are professionally equipped and clinically experienced to mediate when relationships may have become difficult and strained and the need to re-establish a meaningful dialogue between claimant, employer and insurer are vital to unblock a stuck situation and move the insurance claim forward.
Training on mental health for claims assessors
Our training courses, seminars and workshops enable claim assessors to deal effectively with mental health-related insurance claims and the specific medico-legal considerations that may result from such work.
Areas covered include:
Our training combines clinical and legal expertise. Contact us for more information.
Case-based review groups
As claims assessor or manager, you are on the frontline of some challenging personal situations, and it is therefore important that you can access help that is specifically designed to support you in your role.
Grespi offers a consultant-facilitated case discussion service for claims assessors typically provided in a 60 to 90-minute Balint group format, held on site. Balint groups are conducted by consultants specifically trained in this well-established approach, which aims at helping group members to work more effectively in their professional roles. Contact us for more information.
Telephone consultation service for claims assessors
Grespi offers a telephone or Skype consultation service to claims assessors for complex claim situations. These typically involve discussions between a Grespi consultant and a claims assessor on the management of individual claims, claim patterns, or dysfunctional organisational issues. These consultations are normally pre-booked. Grespi guarantees that consultations of 60 to 90 minutes will be available within 48 hours. Contact us to arrange this service.