Psychiatric Work Injuries

Under California workers’ comp laws a psychiatric work injury is a mental disorder that results in you being disabled or in need of medical treatments.  Most people think of workers’ compensation benefits as something that compensates for a physical injury that occurred while at the workplace. There are also those that feel workers’ comp claims are for an illness that developed due to exposure to substances in the workplace. The truth is, while these are the most common type of workers’ comp claims, there are also worker compensation laws that recognize mental, emotional, and psychiatric injuries.

It is more challenging to prove psychiatric injuries as there are no visible signs of trauma. This absence of visual proof often leads to claims getting denied.

California law defines two different psychiatric work injury types. The difference of the claims is based on whether you have suffered a physical injury or condition on top of the alleged mental or emotional damage.

• Mental-Mental

A mental-mental claim does not involve physical injuries and is most likely caused by traumatic or violent events such as experiencing or witnessing a violent act, threats of violence, sexual abuse at work or other violent crime.

• Mental-Physical

A mental-physical claim is the result of psychiatric injuries that happen as a result of physical pain, loss of a profession due to a work-related injury, or diminished functional ability. Examples of mental-physical claims under workers’ comp are depression, anxiety, sleep disorders or panic attacks.

Your psychiatric work injury cannot be a result of a physical injury if you are filing for workers’ comp benefits. There are also stipulations regarding good faith personnel actions performed by your employer that cannot be used as a psychiatric work injury.

• Good Faith Personnel Action

Under California Labor Code 3208.3 it states there is no compensation due by an employer for psychiatric injuries if they were caused by lawful, non-discriminatory good faith personnel actions. The definition of good faith personnel action has not yet been defined in this Labor Code; however, case law has shown what constitutes a good faith personnel action has to be reviewed for each case.

There is a three-part test that will determine whether or not the defense to a psychiatric injury claim can be successful. The first part is to find out if the event can be classified as a personnel action, the second is to decide if the action was made in good faith, and lastly, the event must be proven to have caused a medically or physically psychiatric disability.

When an employer denies a psychiatric work injury which has been filed as a workers’ comp claim stating the event was a good faith personnel action, it is their responsibility, under Labor Code 3208.3 to prove their denial. Your employer will have to show the event was, in fact, a personnel action, and it was made in good faith with a legitimate business necessity behind the action, and that they followed the rules correctly in how the event was carried out. There can be no evidence of discrimination against the employee during these findings.

For you to file a workers’ comp claim for a psychiatric work injury, your employment has to be the predominant cause of your condition. The work you are performing must be more than fifty percent responsible for your psychiatric work injury.

Not only are insurance carriers and employers skeptical about psychiatric work-related injuries, but lawmakers are also concerned with these claims. There have been some special rules attached to psychiatric workers’ comp claims.

When a workers’ comp claim is received by an insurance carrier that is strictly psychological, it is often called a ‘stress’ claim. Sometimes these claims are referred to as ‘mental-mental’ claims as an employee has suffered emotional or mental injuries in their workplace. The injuries are said to be a result of stressful working conditions.

When suffering from psychiatric work injuries, you may be forced to take time off from work to treat yourself as you find it is difficult to impossible to perform specific tasks related to your job. These tasks might include concentrating or communicating with others. An example would be if you suffer from a mental breakdown from being overworked to the point where you are totally exhausted, or if you are being subjected to threats at the workplace, you would have a reason to file a workers’ comp claim.

California treats these comp claims differently than physical injury claims for a couple of different reasons. The first reason is psychological injuries are based on your internal experiences such as your feelings and thoughts. There are no objective tests to measure or detect these experiences like x-rays or blood tests to determine the extent of your injury.

When you state you are suffering from a psychiatric work injury, a doctor will find it difficult to verify your claim. Another problem with psychiatric work injuries is this condition can have a lot of different causes, including some occurring in your personal life that are not related to your workplace. Financial or marital issues in your own life can have a considerable effect on your mental state. Insurance carriers and employers argue that it is to easy to fake psychiatric work injuries or to blame an emotional trauma on work conditions when it actually results from the employee's personal life.

Because so many uncertain factors exist surrounding a psychiatric work injury there are requirements needed in order to receive benefits under workers' comp:

• You must have needed medical treatment as a result of your mental illness or experienced a disability that prevented you from performing your job, or you had to miss work due to not being able to perform your duties
• Your employer must have employed you for six months, even if it was not continuously, unless the psychiatric injury is a result of an extraordinary or sudden event
• You must have a diagnosed ‘mental disorder’ that has been done under accepted procedures
• You will have to prove that your job or place of employment is the predominant cause of your psychiatric injury. This requirement means you have to show there are no other personal issues in your life that could be the cause of your injuries. The insurance carrier is going to investigate your personal affairs and look for any other reason that could be contributing to your condition.

Psychiatric work injury claims are difficult to file as they are difficult to prove. Other reasons your application can be denied include your employer verifying the event you claim caused your injury was in good faith and nondiscriminatory personnel action such as they merely criticized your work or denied you a promotion. Your employer may also state you did not report the injury until after you received a lay-off notice or were fired. Being denied workers’ comp benefits for psychiatric work injuries means you need the help of Workers Compensation Attorney Law Firm to defend you and your rights.

When filing a workers’ comp claim, it is helpful to understand the process involved and to know ahead of time what your chances of success are with your claim. Talking with Workers Compensation Attorney Law Firm about your case will help you know what to expect and get you the help you need to file successfully.

Your claim is going to be scrutinized by the insurance carrier, and they will look into all aspects of your personal life. They are going to check your mental health treatment history, parents, children, criminal history, litigation history, bankruptcies, or any other personal issues that could be related to your mental health. These investigations should be considered when you are planning to file a psychiatric work injury claim so you understand the implications it will have on your personal privacy.

When you prepare to file a workers’ comp claim for a psychiatric work injury, you should put together all the supporting evidence you can to help your claim. Testimony and documents that will help make your case stronger include professional correspondence, psychological evaluations, or any other professional supporting document that will prove your work environment is responsible for your condition.

If your employer is acting discriminatory, is not holding up their promises or contract terms, or are failing to offer you legal benefits are all conditions that can result in psychiatric work injuries as they are considered to be behaving in bad faith. Employers who use appropriate channels for promotion denials, performance reviews, or professional criticism cannot be held responsible.

Determining if your psychiatric work injury is cause for a permanent disability claim would result in two separate issues. The insurance carrier will first determine if there is substantial evidence proving your psychiatric work injury claim. If it is decided you do not qualify for benefits, there will be no medical treatments, temporary disability, or permanent disability claims.

If a doctor determines you have a psychiatric injury, the permanent disability or other non-work related factors will be handled as a separate issue.  When a psychiatric work impairment is identified, it is completed by looking at the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition. The rating of your condition will be determined with the information found in the Global Assessment of Function Scale. This scale converts into percentages and is then adjusted down or up by the guidelines in the Permanent Disability Rating Scale. These are what determines the level your condition can fall under and are what will be used in determining if your illness qualifies for permanent disability benefits:

• 1-10

When your condition is determined to fall within this level, you are considered to be in persistent danger to others and yourself and exhibit a lack of personal hygiene

• 11-20

This level indicates you are in danger of hurting others or yourself

• 21-30

At this level, you show an inability to function and are displaying delusional behaviors along with experiencing hallucinations

• 31-40

Within this range you will have difficulty functioning in a workplace or school environment, and also have problems with family relations as well as have a lack of judgment

• 41-50

You will experience severe symptoms such as suicidal thoughts, minor criminal behaviors, and have difficulty keeping a job

• 51-60

The level will display moderate symptoms such as frequent conflicts with your friends or peers

• 61-70

When falling within this level, your symptoms will be mild such as depression or mild insomnia and minor difficulties functioning

• 71-80

If you are diagnosed to be within this level, you will most likely suffer slight symptoms when faced with stress

• 81-90

This level will have you exhibiting minimal symptoms such as anxiety, but you are considered to be well within the range of normal functioning

• 91-100

This level is the highest rating and indicates you are capable of superior functioning in a wide range of activities

This scoring is used to determine permanent disability and decide if you are eligible for workers’ compensation benefits. You would not qualify for permanent disability unless your rating is less than 70. With a psychiatric work injury, you may be able to return to work under some capacity; you do not have to be totally disabled to receive permanent disability benefits.

You may be able to file a claim for PPD (permanent partial disability) if your doctor states you can work but under certain conditions.

To begin, you must first qualify and meet the eligibility requirements for workers’ comp

• Eligibility Requirements for Workers’ Comp

You must be employed at the business you are filing under

Your employer has to carry workers compensation insurance

Your condition or disability must have occurred due to events at your workplace

You must report the injury within your state’s guidelines

If these eligibility requirements are met and you know that you have coverage under your employer’s workers’ compensation insurance carrier, you then need to file a workers’ comp claim.

• File Your Workers’ Comp Claim

The first step in filing your workers’ comp claim is to report the injury or occupational illness to your employer. There is often a 30-day deadline for you to report the condition or injury once it has occurred or been diagnosed. When the injury has been reported to your employer, you will receive a form to fill out that has to be sent to the insurance carrier.

The insurance company will begin an investigation into your claim, which with psychiatric work injuries will be lengthy and extremely personal.

The third step for applying for PPD (permanent partial disability) is to work with your doctor or the workers’ comp treating physician.

• Workers’ Comp Treating Physician

The rules vary by state on how you will be expected to receive medical treatments for your illness. Whatever the rules are for your state, it is essential you follow them, or you risk your benefits being denied or halted. The program covers all reasonable and necessary medical treatments for injuries deemed to be work-related. This benefit includes doctor’s appointments, physical therapy, surgeries, medications, and any other medical treatment found necessary to treat your illness.

You will continue to receive medical treatments until your doctor verifies you have fully recovered, or determines it cannot become any better. Reaching either of these points in your treatments is known as ‘maximal medical improvement’ stage.

Under your workers’ comp claim, the findings of the doctor will be converted into a rating of your permanent disability and how much your condition will affect the type of work you are expected to perform. It is a complex formula and will take into account your occupation, age, and physical as well as mental limitations. Check with the Workers Compensation Attorney Law Firm if you should have the Disability Evaluation Unit in California’s Division of Workers’ Compensation perform this rating. Not having an attorney to represent you, means you will automatically be required to have the rating.

Just as the permanent disability amount is determined, a permanent partial disability benefit payment will normally equal two-thirds of your average weekly wage. The maximum and minimum amounts are different according to the date of your injury. The reason behind the determination by date are these laws are continuously changing, and the year injury occurred determines what the rates were for that year.

The difference between permanent disability and permanent partial disability benefits is how long you can expect to receive payments. PPD benefits last only a specific number of weeks depending on your rating and the date of occurrence. Working with the Workers Compensation Attorney Law Firm will ensure you receive the correct amount for the proper time you deserve.

Claiming psychiatric work injury will be a difficult and challenging journey through complex legal issues. You need a reliable and experienced legal counsel on your side to ensure you receive the benefits necessary to treat your illness. Call Workers Compensation Attorney Law Firm in Los Angeles at 310-956-4277, so you don’t have to face these battles alone.