If you are struggling with a mental health problem caused by your job in California, you may have thought of filing a workers’ compensation claim. California has one of the most progressive WC systems in the nation, which includes coverage for “psychiatric injuries.” However, it’s no secret that claims based on mental health are often denied by employers and insurance companies.
To be fair, one can understand why there is so much doubt surrounding these claims, but this is why lawmakers have added special provisions for psychiatric injuries resulting from employment. So, let’s take a look at the steps you have to take in order to receive workers’ compensation benefits for a mental health condition.
Workers’ Comp Requirements for Psychiatric Injuries
Work injury claims that are psychological in nature are sometimes called mental health claims or stress claims, due to the fact that they are largely based on stressful conditions at work. As a result, workers may need time off due to their inability to perform certain tasks or work in a triggering environment. Many of these workers are overworked and/or subjected to harassment, threats, and other toxic behavior by their employer. This can cause a mental breakdown that can form the basis of a psychiatric injury workers’ comp claim.
Psychiatric injuries are treated differently compared to physical injuries, and there are valid reasons behind this way of thinking. Primarily, mental health illnesses are based on the person’s thoughts and feelings, i.e., internal experiences. These are not injuries that are visible to others, like a cut on the arm or an illness that’s diagnosed by running tests. That makes it hard for doctors to verify that a worker is afflicted with a psychiatric condition.
It’s also worth noting that emotional injuries have a myriad of causes, including issues that have nothing to do with one’s job (bad marriage, death in the family, etc.). This opens the door for employers and insurers to say that it’s impossible to determine if the injury is work-related.
Hence, the laws in California require employees to prove all of the elements listed below in order to file a psychiatric injury workers’ compensation claim:
- You must have a condition that is diagnosed by a licensed clinician as a “mental disorder.”
- Because of the disorder, you require medical treatment or experienced some level of disability that impairs your ability to work.
- You must have been employed by your current employer for at least 6 months.
- You must establish that your employment is the “predominant” factor in why you developed a psychiatric injury. So, even if other circumstances are taken into account, your work conditions are at least 51% responsible for the injury. Or, if you are a victim of a “significant violent act” at work, the standard is lowered to 35% to 40%.
The last requirement is the most challenging to prove, as it’s more than likely that various factors are involved when someone has serious mental health issues. Thus, employees who are applying for WC based on a psychiatric injury should prepare to have their personal lives scrutinized. Essentially, the insurance company and the medical evaluators they hire will try to find anything else that caused or contributed to your condition, such as:
- Problems with your family
- Financial troubles
- History of mental health disorders
- Current or past drug / alcohol abuse
- Criminal history
Actual Events of Employment in a Psychiatric Injury Claim
To qualify for WC benefits for a mental illness, you must establish that the predominant cause of your disorder is “actual events of employment.” This is a difficult factor to prove, as certain work conditions do not count as an “event” of employment. If, for example, you stressed over your company’s stock loss and financial conditions possibly leading to layoffs and downsizing, this is unlikely to qualify as a basis for a psychiatric injury claim. You also can’t claim benefits for anxiety and stress caused by the WC process from a previous claim for a physical or mental injury.
Stress Caused by Layoffs Notices and Personnel Actions
Below are some other conditions that can cause your mental health workers’ comp claim to be denied:
- You file the claim after notice of being fired or laid off – unless the injuries you are claiming resulted from sudden and extraordinary events in the workplace.
- Your employer can prove that the predominant cause of your psychiatric injury is a non-discriminatory, legal action (denial of promotion, for example).
Benefits from a Workers’ Comp Psychiatric Injury Claim
Another consideration to be mindful of are the benefits you are entitled to as someone with a psychiatric injury. Typically, these benefits are less than what you would receive for a work-related accident resulting in bodily harm. Generally, workers are entitled to medical expenses to treat the condition and temporary disability for time they need off from work.
It’s very difficult to make a case for permanent disability due to a mental or emotional disorder. Even if you have to leave your workplace permanently, it’s generally assumed that you can recovery from your illness once you are in a new work environment. Thus, it is very rare that a psychiatric injury can be used to justify permanent disability payments through the workers’ compensation system.
Physical Injuries at Work that Result in Mental Health Conditions
Sometimes, a psychiatric disorder is related to a work accident that causes significant harm and suffering. In these situations, you’ll have an easier time making a case for psychiatric injuries caused by “actual events of employment.”
As an example, let’s say you sustained a back injury at work that was serious enough to require surgery. Afterwards, you were left with chronic pain that made it impossible to work or perform many basis tasks for several months. There are many credible studies that show long periods of disability and chronic pain can result in psychiatric disorders. Thus, you already have a medically accepted basis for a work-related mental illness claim.
Injuries of this nature are referred to as “compensable consequence injuries,” as they are a consequence of a physical injury. Examples of compensable consequence injuries include sleep disorders, sexual dysfunction, and severe anxiety. To receive workers’ compensation for this type of injury, you must prove:
- The injury occurred prior to 2013.
- You had a catastrophic injury, such as permanent nerve damage or serious burns, or
- You were injured from a violent act during the course of your job duties or traumatized by exposure to significant violence at your workplace
Help from a California Workers’ Comp Lawyer
Psychiatric injury claims are exceptionally complex, and it’s in your best interest to consult an experienced workers’ compensation lawyer. California Labor Law Employment Attorneys Group is here to guide you through the legal process, step by step.
We offer a Zero Fee Guarantee, so there is no need to worry about legal fees when you hire us. Legal fees are paid by the other party as long as we obtain compensation on your behalf. So, if we fail to bring you a favorable resolution, you pay $0 for the cost of legal services.
For more information on filing for workers’ compensation benefits for mental health condition, contact us to schedule a free case review.
