Understanding Workers' Compensation Eligibility for Stress and PTSD-Related Injuries

What is Workers’ Compensation?

Table of Contents

1 What is Workers’ Compensation?
2 What is PTSD?
- 2.1 Diagnosing PTSD
3 Workers’ compensation for PTSD
- 3.1 PTSD as an occupational disease
4 Workers’ comp in different states
5 Workers’ Compensation benefits for PTSD
- 5.1 Special rules for Workers Comp for police officers and firefighters
- 5.2 New laws
6 Consider hiring an attorney
- - 6.0.1 References

Workers’ compensation is put in place to provide benefits for medical coverage and wage loss replacement in cases of injuries related to work and occupational diseases. Compensations for both physical and psychological injuries are supported by law. Anxiety

Psychological injuries such as PTSD and stress may be covered by workers’ comp depending on the circumstances under which the condition developed and your state laws regarding compensation for psychological damage. You may receive benefits for PTSD as an injury, an occupational disease, or as a consequence related to physical injury.

Mental disorders such as depression and anxiety have been neglected when it comes to laws about work-related injuries in the past due to social stigma. In recent years, the awareness of mental conditions such as PTSD has been rising, which resulted in an expansion of laws that regulate injuries in the workplace. Also, it’s common to associate PTSD with soldiers who survived combat. But it becomes more clear that many people develop this condition after many other types of traumas, including trauma at work.

What is PTSD?

PTSD or Post-traumatic stress disorder is a mental health condition that occurs after a person has experienced or witnessed a traumatic event that caused psychological distress, feelings of fear, and helplessness. A person can experience PTSD symptoms right away or there can be a gap between the event and the manifestation of signs of the disease, which can take several months or even years.

Diagnosing PTSD

There are many different signs that the person might be suffering from PTSD since it is a cluster of diverse symptoms.

The first criterion for the diagnosis is going through a traumatic event. That means that the person has been exposed to a situation where their life was in danger, or there was a threat of serious injury or sexual violence. A person might be impacted directly, experiencing the event themselves, or be a witness of such an event. Learning about a close family member, partner, or friend experiencing trauma is also considered as exposure to trauma. Other symptoms may include:

Re-experiencing the event – a person experiences recurrent, intrusive, and involuntary memories, dreams, or flashbacks of the event.
Avoidant behaviors – a person avoids stimuli that remind them of the traumatic situation. That can include places, people, objects, thoughts, or emotions related to trauma.
Emotional distress and change in personality – this might include dissociative amnesia (a condition where a person is unable to remember the event or parts of it), self-blame, persistent feelings of guilt, shame, fear, anger, etc., negative thoughts about oneself, lowered interest and motivation to do the things they enjoyed in the past, and difficulty with social interactions.
High irritability – persistent and recurrent emotional arousal that can include angry outbursts with no apparent reason, problems with impulse control that may lead to careless behavior, or inability to concentrate or sleep.
Reduced functionality – symptoms cause significant difficulties in performing daily activities and social and professional functioning are impaired.

To get a diagnosis, a person must experience symptoms of PTSD for at least one month.

Workers’ compensation for PTSD

There are several different scenarios where an employee that suffered psychological distress related to work can apply for workers’ comp benefits:

1. PTSD as a result of physical injury

This is a so-called “physical-mental” scenario where benefits will be awarded to an employee who developed PTSD after sustaining a physical injury in some kind of accident at work. This type of claim is usually easier to prove than claims in other situations.

2. PTSD as a result of a sudden shock or fright

This is a scenario where an employee seeks compensation because they developed PTSD after a shock or fright that was unexpected regarding the performance of their professional duties. In this situation, a person did not sustain a physical injury, so this is called a “mental-mental” scenario.

There are some guidelines from the Workers’ Compensation Commission regarding what is and is not considered a “sudden shock or fright”. They highlight that precipitating events that lead to psychological injuries must be described as traumatic, unexpected, frightening, shocking, and catastrophic. They also examine if the traumatic event is something unusual when it comes to the employee’s professional obligations and if it was so frightening and dramatic to lead to strong feelings of shock and fear.

3. PTSD caused by multiple work-related traumatic experiences that developed over time

There is no need to prove that a sudden shock caused your mental injury when you find yourself applying for compensation for PTSD that developed over time. In this case, the employee needs to prove that the cause of PTSD is prolonged exposure to multiple traumatic experiences related to work.

PTSD as an occupational disease

You can file for compensation if PTSD is considered a possible occupational disease for your profession. In this case, you need to provide relevant evidence to the Workers Compensation Commission. This includes:

Presenting evidence that there is a direct causal link connecting the conditions of employment and PTSD
Proving the exposure to the traumatic event and that PTSD was a natural incident of the employment
Proving that employment is the main cause of PTSD and that other, non-work-related events are not the main cause of PTSD

Workers’ comp in different states

When it comes to filing a claim for workers’ compensation benefits due to psychological injury claims such as PTSD, states have three ways of treating them:

1. In many states, such claims are covered by workers’ compensation only if the cause can be considered as some kind of extraordinary event. For example, a stress-related injury claim in Nevada will be covered only if the cause is “extreme stress in a time of danger”, however, the state will cover a wider range of such conditions for first responders in case of witnessing death or shocking injuries in violent events. Often the traumatic event must cause some type of extraordinary, unusual stress that was unexpected for claims to pass.

2. Several states provide compensation benefits in cases where an employee suffered a psychological injury at work without any physical injury

3. A small number of states grant compensations for work-related psychological injuries even in cases where the stress is gradual and not unusual for a specific occupation. In some cases, however, it might be quite difficult to prove that PTSD is related to work. For example, in California, an employee must prove that employment conditions make up at least 51% of the responsibility for PTSD, and they must work for that employer for at least six months.

Workers’ Compensation benefits for PTSD

According to Peter V. Bellotti, an attorney at law that specializes in Boston work injuries if a claim is approved, benefits from workers’ compensation should provide employees with a reimbursement for the expenses of the treatment. They also may apply for disability benefits while they are not working due to recovery, or for permanent disability if doctors decide that PTSD permanently affects their ability to work. The average settlement for a work-related psychological injury such as PTSD can vary between 50,000 and 90,000 dollars.

Special rules for Workers Comp for police officers and firefighters

First responders, police officers, and firefighters are at increased risk for PTSD. Empirical data shows that 33% of first responders, 20% of police officers, and 20% of firefighters suffer from PTSD at some point in their lives. Considering that people in these occupations are frequently exposed to violent and traumatic events, it’s no wonder that the frequency of PTSD for them is many times higher than the average for the general population.

New laws

The General Assembly in Virginia recognized this problem and passed a law recently to make it more possible for law enforcement officers and firefighters to receive workers’ compensation for PTSD.

These are the conditions for receiving workers’ comp for firefighters and police officers:

The employee must be examined by a mental health professional who will diagnose them with PTSD related to a qualifying event. Such events involve any situation: that results in serious physical injury or death of another person; involves injury, death, abuse, or exploitation of minors; represents a direct threat to their or someone else’s life, or involves mass casualties.
They must prove that PTSD is a result of performing their professional duties.
The qualifying event must be the main factor that caused PTSD.
They must prove that PTSD is not a result of termination from the job, any disciplinary action, demotion, transfer, retirement, or work performance evaluation.

Consider hiring an attorney

If you sustained any psychological injuries related to work, such as PTSD, you might benefit from contacting a lawyer immediately. An experienced attorney will explain the workers’ compensation laws in your state, and how PTSD is treated by the system. They will help you file the claim, represent you, and deal with the insurance company’s arguments against the claim. A significant part of their job is working with your therapists, mental health professionals, and doctors to acquire documentation that is necessary to prove your claims. They can be an instrumental part of your fight for workers’ compensation.