Insurers are continuously looking for ways to strengthen their understanding of the physical, psychological and social barriers that can contribute to difficulties in recovering from a disability, delaying or even preventing recovery and possible return-to-work.
Seasoned claims managers are generally highly skilled at asking the right questions during case interviews in order to determine any physical and emotional conditions that might result in longer claim durations and poorer RTW outcomes. However, a set of conditions that has recently begun receiving greater notice are the adverse childhood experiences – abuse, neglect and family dysfunction – that may occur during the first 18 years of life.
ACEs are a growing concern for insurers for several reasons. ACEs can have a substantial and deleterious impact on juvenile brain development. Researchers have found that high levels of stress hormones such as adrenaline and cortisol can damage brain structure and function in young people, resulting in ongoing difficulties into adulthood in learning, building trust and healthy relationships, detecting threats, and regulating emotions.
Second, ACEs are far more common than has generally been thought. The Adverse Childhood Experiences Study, a study conducted from 1995-1997 on the effect of childhood trauma by the Centers for Disease Control and Prevention and Kaiser Permanente, found that nearly two-thirds of its more than 17,000 participants (all of whom were Southern California-based Kaiser members) had at least one ACE, and more than 20% had three or more.
Third, ACEs can impact an adult’s general health, including the ability to recover from injury. The magnitude of their impact, according to the CDC/Kaiser study, depended on the types of abuse experienced (emotional, physical/sexual and/or neglect), the family issues that might have played a role in the perpetration of the abuse (parent or sibling substance use, mental illness, incarceration; parental separation or divorce, family violence), and the individual’s age when the abuse took place, as different areas of juvenile brains develop at different times.
In the study, participant responses were scored from 0 to 10, with 10 reflecting the highest amount of cumulative childhood stress. A 2009 paper in The American Journal of Preventive Medicine discussed a review of the CDC/Kaiser study results that incorporated follow-up mortality and morbidity data.
The researchers found that the presence of ACEs has important mortality and morbidity implications. Adults with ACE scores above four, for example, are at increased risk for health impairments such as drug and alcohol abuse, mental health difficulties, respiratory difficulties such as asthma or chronic obstructive pulmonary disease, ischemic heart disease, liver disease, and obesity. In addition, individuals with ACE scores of six or higher die on average 20 years earlier than those without ACEs.
Whether a clearer understanding of ACEs, and how they affect adult health, resilience and longevity, can benefit how insurers underwrite and manage claims is a question worth exploring. Addressing, for example, the scope of LTD claimants’ obstacles to recovery can be challenging without sufficient knowledge of their backgrounds. Indeed, gaps in understanding what might underlie a lack of resiliency could mean gaps in medical care, negatively impacting a claimant’s ability to achieve full and timely recovery. Greater awareness of ACEs may help claims managers gain a better understanding of the elements in a claimant’s psychological makeup that could be impeding a positive outcome. Durations and return-to-work outcomes, especially for long-term cases, might be improved by judicious incorporation of questions focused on ACEs into case manager interviews.
Still, although ACE scoring questionnaires are used in clinical settings, it is unlikely that claims managers would be able to ask claimants to complete even an abbreviated ACE questionnaire, due to legal and privacy issues. Still, gentle ACE-style questions could be incorporated into claim manager interviews scripts, and any information obtained might enable claim managers to recommend mental health support services that might speed recovery.
A full understanding of a claimant’s physical and psychological well-being, as well as how impairments to their well-being can impact mortality and morbidity, is crucial. Incorporating an awareness of ACEs and their impacts into a multidisciplinary approach is a step worth considering. Although discussions pertaining to adverse childhood experiences of abuse and neglect might be difficult to undertake, addressing these topics in a gentle fashion can ultimately benefit long-term claimant recoveries.
— Read 3 Thoughts From Anthem’s Disability Boss on ThinkAdvisor.