The Treating Psychiatrist and Worker's Compensation Reporting

Abstract

Stanley Crumb was a train conductor. Starting long before sunrise, he took passengers from distant suburbs into a bustling downtown. One morning, on his first run of the day, he saw a figure flash before the train. He pulled on the brakes, but it was too late. The train had killed a young woman. Mr. Crumb later learned that the woman had been severely depressed and had left a suicide note, but he could not help blaming himself.Mr. Crumb was shattered by the event. Several weeks after the incident, he still could not sleep because of horrible nightmares. He kept having flashbacks, and in a disturbing variation he imagined jumping in front of a train himself. At the urging of his wife and his supervisor, he went to the employee assistance program and was referred for evaluation for psychiatric hospitalization. It was determined that Mr. Crumb needed to be hospitalized.Dr. Young was his psychiatrist at the hospital. She diagnosed Mr. Crumb with posttraumatic stress disorder (PTSD). She started him on medication for depression and nightmares and on cognitive behavioral trauma therapy. After discharge, Mr. Crumb continued to see Dr. Young on a weekly basis.Mr. Crumb was benefitting from psychiatric care, but it became clear to Dr. Young that PTSD was not his only problem. Mr. Crumb had a strong family history of mental illness, and several episodes in his past suggested to her that Mr. Crumb might have bipolar disorder. Dr. Young encouraged Mr. Crumb to continue treatment to better understand the nature of his illness.One afternoon, Mr. Crumb arrived at her office in great distress. His insurance company was challenging the necessity of his continuing with therapy through his worker's compensation. Worse still, they were disputing payment of Mr. Crumb's hospitalization. Mr. Crumb hired an attorney and asked Dr. Young to provide a written statement about his current mental state and need for hospitalization.A few days after submitting her statement, Dr. Young received a call from Mr. Crumb's lawyer. He asked her to remove certain sections of the written statement. Specifically, he wanted her to redact the section about her suspicions of preexisting bipolar disorder. It would destroy Mr. Crumb's chances of getting compensation, the lawyer warned.