Is your mental health covered? Insurance for psychological injury

As we start Mental Health Awareness week, this blog highlights one area of concern for organisations aiming to meet their duty of care.

Is your mental health covered?

Increasingly aid organisations are building mental wellbeing into their policies and ethos. But if the worst happens is their insurance in line with their policies? We know medical insurance covers physical injuries, but does it cover psychological ones such as PTSD (post-traumatic stress disorder) or burnout?

Most aid workers in the world are local hires, often in countries with inadequate or collapsed health systems due to disasters or conflict. What is covered in their insurance? The costs of treatment are significant, but so is the impact on an employee’s ability to work. How far does an organisation’s duty of care – both moral and legal – need to go?

Support for mental wellbeing is often provided through an Employee Assistance Programme (EAP). This can include psychosocial support for staff involved in a crisis, but is this enough? Six or twelve sessions of specialised psychotherapy support has become a norm. However, it is unlikely this will be sufficient for somebody suffering debilitating psychological harm. From personal experience, it took me about three years of therapy to regain my sense of self after experiencing trauma and burnout following missions in Afghanistan and Pakistan.

An example of insurance not matching policy

In the ongoing German court case, Mauchline vs. CADUS e.V., a spotlight has been cast on unsupported psychological injuries. Although CADUS’ policies emphasise psychological well-being and the provision of psychological help in unforeseen, violent situations, the reality experienced by aid worker Simon Mauchline tells a different story.

After enduring 48 days of detention and torture while deployed in Syria, Mauchline reports that neither the organisation, nor its insurers, would agree to assist his recovery from the impacts of his psychological injuries. This raises significant concerns about the legal responsibility of aid organisations and the insurance they purchase.

While some insurance providers do support psychological injuries, the level of cover cannot be assumed and needs to be properly interrogated.

What types of insurance might be activated for psychological care?

I asked William Wakeham of Price Forbes, whether ‘employees are generally covered for psychological injury?’ His answer started well, ‘yes, they should be’ but then he added, ‘however it is easy for psychological injury to fall through the gaps between the patchwork of different insurances’.

Organisations may have different medical insurances:

• Special Risks insurance – covers injuries sustained during a high-risk event, e.g. illegal detention.
• Emergency Medical insurance – covers evacuation and repatriation, medical care during the emergency phase and, possibly, a three-month ‘at home’ period.
• International Medical insurance – covers longer-term care and treatment costs.

These insurances may cover treatment costs for psychological injury, but it is not guaranteed. They also, usually, anticipate that once ‘home’ the national medical service (e.g. the NHS) will kick-in. This can become an issue when the employee’s home is not the same as that of the employing organisation, or where there are other barriers to accessing care.

As well as requiring treatment, psychological injuries can debilitate individuals, severely impairing their ability to work. Trauma symptoms may prevent full working days, and even if there is improvement, returning to previous roles might not be possible.

The insurances above only cover treatment, so this is where the other part of the ‘patchwork’ needs to be considered:

• Workers compensation insurance – this pays a percentage of salary to normal retirement age when there is a permanent disability.
• The “Total Permanent Disablement” element of a personal accident policy. This provides income replacement for a defined period at a percentage of the normal wage.

Again, the small print must be checked to see if psychological injury and disability are covered, and to what extent.

There are further complexities related to pre-existing trauma, a common issue with car insurance providers in the UK. MIND provide some guidance on this question if you’d like to know more.

For instance, one aid worker received psychosocial support post-incident in Somalia. It was later revealed that the incident had triggered prior trauma. As a result, the organisation’s legal team determined that support would only be provided during the contract term, unlike for a physical injury where long-term support would be extended post-contract.

One further point to consider is that PTSD, the most well-known psychological injury, will not be formally diagnosed until at least three to six months after an incident. An organisation’s insurance may not cover for injuries diagnosed after the contract has finished. This is where an Employer’s Liability policy, with a “tail” for historic claims, may apply, if the employer were deemed liable.

What can be done?

Organisations should adopt a holistic approach to insurance for psychological injuries. Employing a broker familiar with the sector, who can help organisations navigate its specific complexities, can be beneficial.

Individuals should assess their own risks and enquire specifically about their coverage, especially if volunteering, on a defined term contract, or otherwise not viewed as a ‘full employee’. It’s important to thoroughly read and seek clarification on anything not clearly stated.

And remember, always read the small print.