Workers’ Compensation Mental Health. Do I have a Psychiatric Injury Claim against my employer?

February 10, 2022

Workers’ Compensation Mental Health. Do I have a Psychiatric Injury Claim against my employer?

Per California workers’ compensation law, a psychiatric injury may be a mental, emotional, or psychiatric condition stemming from either working conditions, a work injury, or a traumatic experience that took place at work.

What are the specific requirements to claim a psychiatric injury?

Specifically, for a psychiatric claim to be recoverable/compensable, the employee must show:
        1. They have been employed by their employer for a total of at least 6 months, whether it be continous or not (6 months criteria need not be met if the injury was a result of a sudden and extraordinary occurrence); and
        2. Either:
          • The events of employment were the predominant cause of the injury (typically meaning the work caused greater than 50% of the injury); or
          • The injury resulted from a violent act that was substantially caused by employment events (typically meaning the work caused 35-40% of the injury); and
        3. And:
          • The injury is a diagnosed condition pursuant to the Industrial Medical Council.

Example 1: Lisa’s supervisor at work persistently harassed her every day; insisting she needs to work more hours, work faster, and that she should be ashamed that her colleagues work harder than her. On top of this, Lisa’s clients are calling her every day, yelling at her on the phone and further aggravating the extreme stress her supervisor is putting her under. Her work begins to take a toll on her life, as she cannot eat nor sleep. She ultimately has a panic attack and is taken to the hospital. Lisa may file a psychiatric injury claim given her anxiety and stress stems from her working conditions.

It is worth noting the insurance company will likely dig into the employees’ personal and medical history in search of external factors causing the psychiatric condition, in an attempt to negate the fact that events of employment were the predominant cause of the injury.
If an employees’ psychiatric injury stems from a physical work injury, rather than work conditions; the psychiatric injury may obtain treatment but the injury may not be used to increase an employees’ disability benefit amount, unless the employee is the victim of a violent crime or catastrophic injury (such as loss of a limb, paralysis, serious burn, or serious head injury).

Example 2: Mary’s leg gets caught in a machine she was operating at work, and as a result is amputated. Due to the loss of her leg, Mary grew extremely depressed. She may add a psychiatric claim to her physical work injury claim due to the fact that her original physical injury was a catastrophic injury (loss of a limb) meeting one of the two exceptions.

What if I am injured before being terminated from my job, but do not claim a psychiatric injury until after being terminated?

In this situation, the employee would need show that they meet criterias 1-3 above (6 months of total employment, employment events being a predominant cause or violent act being a substantial cause, and diagnosed condition per Industrial Medical Council), plus they would also neet show at least one of the following statements pertains to them:

  1. Sudden and extraordinary employment occurrences caused the injury.
  2. The employer had notice of injury before the employee was terminated.
  3. Medical records dating before the employees’ termination indicate treatment of the injury.
  4. A trier of fact finds racial or sexual harassment.
  5. Evidence reveals that the date of injury was after the date of notice of termination but in fact before the actual effective last day of employment.
    • Example 3: Roger, a cashier at a gas station, is held at gunpoint during a robbery and thus suffers post-traumatic stress disorder (PTSD) as a result. Roger may file a psychiatric injury claim because his PTSD resulted from a traumatic experience that took place at work. Also this would be categorized as a sudden and extraordinary occurrence and would thus not require Roger to have worked for the employer for a total of 6 months in order to file a psychiatric injury claim.

Consult with an experienced attorney for more information

If you believe you have a psychiatric injury claim, our experienced and skilled workers’ compensation attorneys can help you navigate the process to get the benefits you deserve. Your justice is our priority. Find Out What Can We Offer You?

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