Are Workers’ Compensation Insurers Creating More Luigi Mangiones?

The impact of physical pain on mental health

The impact of physical pain from work-related injuries is profound and far-reaching. It’s intuitive that ongoing physical pain is bad for your mental health, but studies show exactly how bad it can be.

A 2017 study analyzing medical literature regarding pain and depression found that, while depression is present in about 5% of the general population, 30% to 45% of patients with chronic pain experience depression. The study also found that chronic pain and depression can make the other problem worse: Depression can be a positive predictor of chronic pain and can make people more sensitive to pain, while chronic pain increases the risk of developing depression and makes depression symptoms worse. (I appreciate the study but it is common sense that constant pain can cause depression.)

A study of over 1,000 injured workers published in 2022 found that those who experienced continuing pain 18 months after their injury were more than twice as likely (33% vs. 16%) to be unemployed than workers who reported no pain. The study also found that the workers with chronic pain had nearly 50% higher lost earnings and over 100% higher healthcare costs.

Keep in mind that this study was conducted in Ontario. The difference in healthcare costs for those with chronic pain will almost certainly be higher for injured workers in the U.S. because healthcare costs are higher in the U.S.

Again, it’s probably no surprise that workers with chronic pain are also more likely to have suicidal thoughts or even to attempt self-harm. In fact, one study found that the stress of pursuing a workers’ compensation claim may be associated with poor mental health or suicidal behaviors.

To put it more plainly, injured workers with chronic pain are already more likely to be depressed because of the pain from their injury. The games insurers play regarding paying out claims add additional stress that increases workers’ physical and mental suffering.

Workers’ compensation insurers’ gamesmanship

Workers’ compensation insurers have a simple business model: Employers pay premiums to them and, in exchange, the insurers agree to pay for their covered expenses. Insurers make their money, obviously, by collecting more in premiums than they pay out in claims. To them, it’s good business to delay, reject, or reduce legitimate claims for compensation.

Unfortunately but unsurprisingly, workers’ compensation insurers play games with injured workers to protect their bottom line at the expense of those workers’ health and well-being. Those games are well-known to workers’ compensation claimants’ attorneys.

One game insurers often play is denying claims based on technicalities. They’ll deny claims based on minor omissions or inaccuracies in the filing paperwork, even though the claim and injury are legitimate.

Another game they play is misclassifying injuries. Insurers will classify injuries as non-work-related even if the injury unquestionably occurred on the job. They may also claim that the injured worker was engaged in “horseplay” and that the injury therefore doesn’t qualify for workers’ compensation benefits.

Insurers frequently delay claim processing. They often flout rules and regulations that require them to process claims within certain periods of time. Workers are left flapping in the wind, unsure of whether their medical bills and lost wages will be paid for weeks or months.

Insurers also direct workers to specific doctors with whom those insurers have relationships. Those doctors know who butters their bread. They do not provide impartial medical opinions and advice to injured workers in desperate need of effective treatment, regardless of how much it might cost insurers. They instead often prescribe treatment that is cheaper and less effective than what they would have prescribed their own friends and family.

And, of course, insurers pride themselves on disputing some or all of a worker’s injury or the events that led to it. Insurers frequently dispute the cause of an injury or only partially accept claims. Sometimes, this denial is based on an inadequate investigation of the events that led to it, while other times the denial is based on technicalities or missed deadlines. This can lead to a lengthy appeals process for the worker—after likely waiting a long time for the insurer’s initial decision. All the while, the worker is still in pain and still struggling to provide for their family.

These aren’t all the games workers’ compensation insurers employ to wear down injured workers, but you get the idea. These tactics can lead to injured workers getting none of the help they’re entitled to under the law for years while they’re dealing with endless stress trying to secure the benefits they’re owed—on top of them having to deal with potentially life-altering injuries too.

How insurers’ games prolong physical pain and can push injured workers over the edge

Imagine a worker getting hurt on the job, knowing their workers’ compensation benefits they’ve given up their constitutional right to a jury trial for should fully cover medical care and lost wages. When the injury results in chronic pain, the worker is under the impression the medical benefits and lost wages they’re entitled to should help them recover and adjust to the long-term effects without harming the quality of life their family enjoys.

But, instead, their employer’s workers’ compensation insurer plays games like those I described above.

As a result, the worker might need to delay or forgo treatments for their injuries because they’re not sure whether they can pay the bills for those treatments when they come due—and when bill collectors call. The worker may go into debt as their injuries prevent them from promptly returning to work.

While this is going on, they’re spending hours on the phone with the insurer’s customer service representatives attempting to secure their benefits. And, adding to the stress, they could be accused of lying about what happened to them or be mistaken on key points that require months of additional follow-up to resolve.

As the studies I cited above suggest, the pain from a worker’s injury can increase their depression and anxiety, and the stress from trying to get their workers’ compensation benefits compounds the financial stress of being unable to work or afford treatment. Between the ongoing physical pain and stress, it’s easy to imagine those workers feeling desperate and angry about their situation. The ongoing physical pain could lead to depression and other mental health problems, which could go on for years.

Given this physical pain, combined with the stress of trying to put food on the table for their families while injured or at a reduced rate of pay, and the possible onset of mental health issues, it should surprise no one that an injured worker could contemplate or engage in disruptive or even criminal behavior directed at people who work at organizations, like workers’ compensation insurers, whose games, delays, and denials destroyed that worker’s life.

A profit-driven game that leads to tragic consequences

Let me be clear, I do not endorse the actions that Luigi Mangione took. What he did was neither a laudable act of civil disobedience nor a heroic stand: It was a violent crime. And, I would never suggest that injured workers use physical violence or commit crimes if they feel workers’ compensation insurers wronged them.

But, if we are to believe news reports, Mangione was motivated in part by years of chronic pain and frustration with this country’s healthcare and insurance systems. Injured workers with chronic pain, already likely to experience mental health issues because of their injury, may feel a similar level of frustration—alongside desperation.

The studies I cited above show pain and depression can form a feedback loop where pain increases depression and depression increases sensitivity to pain. But we don’t need studies to know that being hurt and out of work is also stressful and can wear down even the strongest, toughest workers, perhaps driving them to do things they wouldn’t normally do.

Injured workers are already struggling. When workers’ compensation insurers play games with those workers’ claims—which wreaks havoc on an administrative scheme that is supposed to serve as a safety net for workers who gave up their constitutional right to sue their employers—those injured workers feel additional frustration and pain, which could lead to mental health issues and them engaging in acts they’ll soon regret.

Systems that are built for fraud and abuse without consequence will have fraud and abuse. Furthermore, when an insurer’s denial of benefits presents a financial incentive or upside—because most people won’t fight back against it—denials become part of the business model. Unfortunately for Mr. Thompson, the level of frustration and anger reportedly felt by one lone individual who was on the wrong end of that business model was literally murderous.

A review of our case files—and surely those at other personal injury and workers’ compensation law firms across the U.S.—would reveal literally universal anger and frustration at employers and insurers on the parts of injured individuals and their families. That’s why we train our front line staff members and attorneys to almost be therapists. We train them to have compassion, empathy, to be active listeners, and to explain how we can help clients fight back.

Given the state of the U.S. healthcare system and the business models workers’ compensation insurers employ, it’s fair to ask whether the games those insurers play, and the mental health issues those games may cause, could create more Luigi Mangiones: People living with chronic pain that may cause mental health issues that, in turn, lead them to lash out, become violent, and even commit crimes.

Samuel H. Pond is the managing partner of Pond Lehocky Giordano, Inc. the largest workers’ compensation and social security disability law firm in Pennsylvania, and one of the largest in the U.S. He can be reached at spond@pondlehocky.com.

Reprinted with permission from the May 8, 2025 edition of The Legal Intelligencer © 2025 ALM Media Properties, LLC. All rights reserved. Further duplication without permission is prohibited, contact 877-257-3382 or reprints@alm.com.