HOUSTON — Samuel Walker saw combat in Iraq firsthand: He was splattered with human flesh and shrapnel in a dining hall when a suicide bomber blew himself up just a few feet away.
When Walker got back to the U.S., he brought some of the battlefield home with him. He heard phantom screams in broad daylight, smelled gunpowder that wasn't there. A loud noise would send him into a defensive crouch. He'd been eating French fries in the mess hall at the time of the blast, and the sight of a McDonald's restaurant now brought back violent memories.
Two doctors diagnosed Walker with post-traumatic stress disorder, or PTSD, directly related to his close encounters with violence in Iraq.
But Walker was not a combat soldier. He was a civilian recreation supervisor for KBR, the largest contractor in Iraq. And instead of getting the medical and counseling help he sought, Walker, a U.S. Army veteran, found himself caught in a morass of red tape and rejected insurance claims.
A Times investigation of a taxpayer-financed insurance system, based on reviews of scores of cases, has found a pattern of repeatedly blocked claims for treatment of psychological injuries sustained by civilian workers in Iraq and Afghanistan.
Some seriously afflicted contract workers have been dumped into indigent medical care programs, according to court records. Many have had to wage lengthy legal battles to win payments for psychological treatment. At least four have committed suicide after returning home from Iraq, according to court records and interviews with attorneys and family members.
Although insurance companies have paid for counseling for many workers, they also have fought claims for psychological treatment more than for other types of injuries, according to data compiled by The Times from Department of Labor records.
Though contractors claiming psychological problems made up about 4% of nearly 1,400 serious reported injuries from 2003 to 2005, such workers accounted for 13% of the cases fought out in courtrooms.
In fighting claims, the insurance companies have relied on doctors with questionable expertise, according to court records and claimants' attorneys.
In one case, an insurance company psychiatrist who specialized in pharmacological research broadly dismissed psychology as "baloney." In another, a psychologist hired by insurance giant American International Group, or AIG, for his supposed expertise in PTSD had seen only 10 to 15 cases in a decade of practice.
The companies have disputed some cases in which their own doctors determined that workers were suffering psychological damage, court records show.
Gary Pitts, a Houston attorney who has represented more than two dozen contractors with psychological problems, said contractors "put their lives on the line, and then they have to wait to get benefits" while insurance companies fight their claims.
The system "is costly; it's inefficient; and it's inhumane," he said.
Insurance companies defended their handling of psychological claims, saying that such cases required more time to diagnose and more documentation to process. They denied any financial motivation in delaying payments.
AIG has the largest number of claims from Iraq. The company said it paid more than half of the claims for psychological injuries, compared with more than 90% of claims for all injuries.
The firm declined to comment on individual cases but said it hired only qualified experts to assess its claims.
"Companies benefit, both from a financial perspective and a customer satisfaction perspective, to settle claims as quickly as possible," said Chris Winans, an AIG spokesman. "We are in the business of paying claims and in the business of making people's lives whole again."
AIG fought Walker's claim for nearly a year and a half, despite a finding by one of its own experts that Walker needed psychological treatment -- until July 2006, when a judge finally ruled in Walker's favor.
Walker said that he understood that working in Iraq could be risky, but that he never expected his toughest battles to take place after he returned home.
Insurance company officials "were fighting because they didn't want to pay," said Walker, 46, a Georgia resident. "Whatever they could do to keep it going as long as possible, they did. They were hoping that I would give up and let it go."
Sharing the battlefield
Walker's is one of scores of cases trickling through an outdated workers' compensation system designed to provide insurance for contractors working overseas.
Originally designed in the 1940s for contractors erecting bases in the South Pacific during World War II, the Defense Base Act was supposed to provide medical care for typical workplace injuries.
The act required contractors to purchase insurance for workers. Because the premiums were included in the price of the contracts, U.S. taxpayers paid them.