When you file a claim after a construction site injury, coverage for mental health services will vary according to the policy.
If you are claiming your personal injury on a third party’s general liability policy (AKA commercial liability insurance), your psychiatric services can likely be covered if you can prove they are “reasonable and necessary.” Workers’ compensation policies may also cover mental health services under the same circumstances.
Anyone who has been hurt and is worried about covering mental health services can speak to an experienced New York construction site accident lawyer.
The Weinstein Law Group can help you investigate your accident, document your damages, and put forth a strong claim for needed coverage based on the language of the policy in question.
Call us today at (212) 741-3800 or contact us online to schedule a free, no-obligation case review. We’re ready to discuss the legal strategies needed to claim all of your treatments.
General information about the availability of mental health coverage and why it is so important can be found below.
Seek Counselling and a Full Mental Health Diagnosis
After you get hurt during a construction site accident, you should take steps to care for your mental wellbeing as well as your physical wellbeing. Be sure to speak to a qualified professional mental health counselor to evaluate your current condition after the accident.
If you have been experiencing symptoms of particular mental health conditions, such as depression, generalized anxiety disorder (GAD), or post-traumatic stress disorder (PTSD), take steps to address it. You wouldn’t ignore an infected cut, so don’t ignore lingering mental health issues, especially if they interfere with your ability to lead a normal life.
A construction site accident can be a particularly traumatic event, especially if it resulted in a major injury. Just like a medical doctor is needed to fully diagnose your physical condition, it is prudent to get a full psychiatric evaluation to see if there are any lingering traumas or mental health conditions that resulted from the injury.
Coverage for Your Mental Health Services, Counselling, and Psychiatric Therapy Mandated by Law
Unfortunately, many construction injury victims neglect the mental component of their post-accident care. In fact, Americans tend to neglect mental health services in general.
For example, Congress passed a mental health parity federal law in 2008. It mandates that group health plans and health insurance providers offer the same amount of coverage for mental health services as they would for medical health services. Despite the availability of such coverage, 90% of Americans weren’t aware that the mental health parity law exists, according to a 2014 American Psychiatric Association (APA) survey.
Mental health treatment related to an injury must be covered by no-fault personal injury protection (PIP) auto insurance plans. It is typically covered by workers’ compensation plans, so long as the claimant can establish a connection between the mental condition and the injury event.
General liability policies may also allow provisions for mental health care if the claimant can sufficiently demonstrate that the services were “reasonable and necessary” and directly related to the covered incident.
Seek the counseling and other services you need as soon as possible. Discuss your legal options for claiming these services with help from an experienced construction accident lawyer in New York.
How a New York Construction Accident Lawyer Can Help
Coverage for any given service is never guaranteed. However, several factors can increase your chances of a successful claim for psychiatric counseling.
Get a Referral From Your Treating Physician
First, obtain a referral. Discuss any mental or behavioral symptoms you’ve been feeling with your doctor when receiving your initial post-accident diagnosis. Mention these symptoms again at follow-ups if they persist.
For example, you should pay attention to your own daily experiences to look out for signs of PTSD. Common symptoms of PTSD include:
- Recurrent distressing thoughts or dreams about the event
- An instinct to avoid the location of the event or physical and mental reminders of it
- Feelings of ongoing anxiousness, stress, or tension
- Being jumpy in reaction to certain events
- Feelings of social isolation
- An inability to sleep at night
You can ask for a referral from your treating physician, but make sure that your symptoms are being documented in connection with your concerns.
Attend All Appointments and Follow All Recommendations
Once you receive a referral, attend appointments as recommended by the physician and/or your treating mental health therapist. Don’t neglect your appointments or decide on a self-care regimen.
If you do not feel comfortable with some recommendations – such as if you’re reluctant to take antidepressants – make sure that the mental health provider notes your wishes and has the opportunity to provide alternatives.
Doing things like skipping appointments or failing to follow recommendations can allow insurers to allege two things:
- You are causing self-harm by neglecting recommended treatments and any possible aggravated mental condition is not going to be covered since it’s no longer related to the incident, or;
- Your mental health “injuries” are not as severe as you claim. Otherwise, you would be seeking treatment as recommended
Save All of Your Billing, Discharge, and Non-Sensitive Client Information
To obtain coverage for your therapy, you must provide proof of your “damages”, which are your counseling bills and other charges. You must also be able to provide a specific diagnosis or general treatment plan to the insurer.
Remember that some incidental expenses related to care can also be claimed. For example, the cost of getting transportation to the appointment, or parking deck fees.
As such, save every possible receipt and bit of documentation. You and your attorney can review these documents to determine what is relevant and what could aid your claim.
Be Prepared for Common Reasons Insurers Use to Deny Coverage
You and your construction injury lawyer can work to anticipate common tactics insurers will use to avoid covering some or all of your mental health treatments.
These tactics include:
- Alleging your treatments weren’t “reasonable and necessary”
- Alleging that your mental health condition wasn’t directly related to the event, such as if you had a pre-existing condition
- Using policy technicalities or exclusions to avoid covering some or all of certain bills
The third technique in particular can be tricky for claims involving mental health treatments. As such, be sure to review the policy closely to see if any types of treatments are excluded. In some cases, you may be expected to utilize a certain provider network to get your costs covered.
You and your attorney can review the policy, prepare your claim with in-depth documentation, and research things like prior case rulings to anticipate common reasons for refusing coverage. If your claim turns into a lawsuit, this preparation can benefit you during a jury trial or out-of-court litigation.
Fight for the Coverage You Need With an Experienced New York Construction Accident Lawyer Team
The Weinstein Law Group puts clients first. We want you to feel comfortable not just seeking psychiatric counseling but claiming its cost on your personal injury insurance claim.
During your case review, you will be informed of your rights and common legal strategies that can help you increase your chances of getting the maximum compensation available. If we decide to work together, you will gain an ally in your journey to heal and move on from your traumatic injury event.
Find out more about how we can help you during a free, no-obligation consultation when you call (212) 741-3800 or contact us online today.