Workers Comp for Mental Health Conditions

Physical injuries and illnesses brought on by workplace mishaps or conditions are comparatively easy to substantiate and, as a result, comparatively simple to get sorted under workers compensation.

By contrast, when it comes to work-related mental and/or psychological injuries, it sometimes sounds as though workers comp coverage is virtually impossible to secure.

Or is it?

What could a Manhattan software company intern, an Iowa 911 dispatcher, a Philadelphia corrections officer, and an Arizona sheriff’s deputy possibly have in common? Just this: Each made a newsworthy, ultimately successful claim to have workers compensation cover their job-induced mental trauma.

Daniela Sawyer, a 31-year-old intern, swooned from an asthma attack triggered by being trapped in an elevator the employer knew to be faulty.

Mandy Tripp, an emergency services dispatcher for Scott County, Iowa, won compensation based on post-traumatic stress linked to a call from a mother screaming for help for her mortally injured baby.

Philadelphia prison guard Dion Jones was awarded benefits over a claim of PTSD after he witnessed the shooting death of an inmate just released from custody.

And, on appeal, former Gila County, Ariz., sheriff’s deputy Sgt. John France, won workers comp benefits after a June 2017 confrontation with a suspect who pointed a double-barreled shotgun at his head resulted in PTSD.

None of the above suffered anything in the way of lasting — indeed, even days-long — physical setbacks. But their ongoing psychological impairments earned benefits under existing workers compensation statutes in their states.

In short, there is hope for employees who have suffered job-related mental trauma to recover workers compensation benefits.

Does Workers Comp Cover Mental Health?

The answer to whether workers comp covers mental health is hinted at two paragraphs above. The key phrase: statutes in their states.

“Up until a few years ago, there were no laws addressing workers’ compensation for mental health conditions,” Juan Dominguez, a Los Angeles-based workers comp lawyer, said. “Even now, new and updated laws addressing employee mental health and workers’ comp are regularly being enacted.”

Mental health provisions are an emerging field of workers compensation legislation. In 2022, state legislatures considered at least 61 bills addressing workers comp for workplace-connected mental injuries. Only four passed, however (Colorado, Maine, New Hampshire, Florida) and legislation was pending in New York.

At the start of 2021, only seven states (Montana, both Dakotas, Kentucky, Alabama, Georgia, West Virginia) specifically excluded mental injuries in statute. That number shrank by one when West Virginia adopted coverage for first responders beginning July 1, 2021.

At the same time, 10 states (Kansas, Mississippi, Iowa, Illinois, Indiana, Pennsylvania, New Jersey, Delaware, Maryland, North Carolina) were silent about coverage.

The rest specify at least some sort of coverage for employees whose work is linked to psychological distress. As noted above, those statutes continue to evolve. Meanwhile, courts increasingly are interpreting statutes to favor workers with mental health workers comp claims, enough that risk-management advisers are recommending employers get ahead of the curve by adding the psychological health rider to their policies.

“Our society has evolved considerably when it comes to mental health issues,” Dominguez says. “Most states now make special allowances for employees in typically high-stress jobs, such as first responders but a few still require those employees to have a physical injury too.”

Consulting with your human resources department, the local office of your state’s department of labor, or, better still, finding a good workers comp lawyer are the best ways to learn whether, and to what degree, work-related mental disorders are covered in your state.

Mental Health Conditions in the Workplace

Mental health disorders fall into a variety of categories. Those that can be connected to work include stress, anxiety, depression, and PTSD. Each can present itself individually, or in combination with other psychological maladies.

Let’s have a look at the symptoms and whether, if they’re job-related, workers comp benefits adhere.

Stress

Stress in the workplace shows up in a variety of symptoms, including fatigue, stomach upset, trouble concentrating and/or sleeping, social withdrawal, muscle tension and/or headaches, and resorting to drugs or alcohol to cope. Workers comp benefits can apply when job-linked stress compromises the employee’s ability to accomplish typical day-to-day activities.

Anxiety

Anxiety and stress share many symptoms: social withdrawal, fatigue/exhaustion, sleep disorders, and turning to drugs or alcohol for relief. Anxiety symptoms also include constant worrying, feeling a sense of impending danger or panic, trouble concentrating or remembering things, losing interest in your work, or becoming apathetic. Again, workers comp benefits may be available if the employee can prove their anxiety is work-related.

Depression

Depression resulting from workplace concerns appears as increased anxiety; an overall sense of boredom or complacency; low energy and/or absence of motivation; prolonged sadness; feelings of hopelessness, helplessness, worthlessness, or immobilizing guilt; becoming error-prone; tension-related physical complaints, such as headaches, fatigue, upset stomach; absenteeism, tardiness, leaving early; irritability; self-medication. If proof exists that the employee’s depression is job-induced, workers comp may apply.

PTSD

PTSD presents much as stress, anxiety, and depression but amplified. Add to those disabilities hyper-reactivity, emotional numbing, negativity, work avoidance, intrusive thoughts, flashbacks, self-blame, and blaming others. When provable, PTSD absolutely is covered by workers comp; indeed, many states name PTSD specifically as an injury covered by statute.

Filing a Workers Comp Claim for Mental Health

Filing a workers compensation claim for mental health injuries is no different than the process for seeking benefits from a job-related physical injury or illness.

Begin by reporting your condition to your supervisor or human resources department. Ask for the forms necessary to file a claim. Follow the instructions from your employer or its insurance company about getting an initial diagnosis.

“All states require the condition to be medically diagnosed by a treating physician,” Dominguez says. “There must be detailed medical records of the employee’s treatment, any medications they are taking, how the disorder developed and their overall background, to name just a few of the requirements.”

Make certain the information you provide the physician is accurate, honest, and complete. Make certain, also, the initial report filled out by your employer or its insurance provider accurately reflects your information.

Because proving your psychological disability is likely to run uphill all the way, strongly consider consulting with a workers comp lawyer right away.

Proving Your Mental-Health Condition Is Work-Related

As noted above, broken arms, fractured fingers, sprained ankles, and even repetitive-stress injuries (from strained backs to wrists aching with carpal tunnel troubles) are a workers comp picnic compared to proving a mental-health impairment is job-connected.

It’s not enough to demonstrate you are depressed, anxious, all stressed out, or suffer PTSD flashbacks. As if modern, first-world life weren’t already overflowing with attacks on our psychological well-being (finances, relationships, family conflict, putting yips), along came the pandemic with lockdowns and school-closings and masks and feuds over vaccines to remind us that worrisome as things are, they always can get worse.

“Many times,” Dominguez notes, “employers and workers’ comp insurance companies will go over the employee’s background closely to see if they can argue the mental health issues were caused by factors outside of work. For example, if the employee recently went through a bitter divorce, that will certainly be brought up.”

Isolating the cause of your sagging mental condition, then connecting it to your job, are essential to a successful workers comp claim. Areas on which to focus:

• Your condition has been diagnosed by a mental health professional. It’s not enough to be perpetually annoyed, generally apathetic, lethargic, or moody. Your affliction may be nothing more than Monday Morning Syndrome. You need a specific diagnosis of a mental health malady, and that must be well-documented.
• Your mental-health impairment must stem from a workplace injury or an unusually traumatic job-related event (or you are a first-responder). Typical stressors, such as an unflattering review, disciplinary action, or being passed over for a promotion, won’t do.
• You can identify, through your mental health professional’s notes, or perhaps by use of email correspondence (with colleagues, family, or friends) or a diary/journal, specific work-related events or incidences that were harrowing and well out of the normal course of business. Having contemporaneous evidence of the triggering event(s) is always useful.
• You have a workers comp lawyer on your team who successfully has handled mental health claims.

Workers Comp Benefits for Mental Health Condition

Depending on the state, if the claimant prevails, (s)he would be eligible for benefits similar to those of a coworker who was sidelined by a physical injury: medical expenses and wage-loss benefits.

Review the latest information on your state’s workers’ comp board website. Another possible benefit includes retraining programs for those who need to move to a new position or change careers.

Average Workers Comp Settlement for a Mental-Health Condition

It is entirely possible that, once established, a claimant’s work-related mental-health injury could lead to the negotiation of a workers comp settlement. Because the statutes and law continue to rapidly evolve on this front, ranges and averages are difficult to establish. And it is the brash attorney, indeed, who predicts what an individual case is worth at settlement.

Factors that will come into consideration include:

• The long-term effects of the mental condition.
• The severity of the mental health condition and its effect on the worker’s life.
• What the worker’s earnings were when (s)he was diagnosed.
• The worker’s ability to return to the job, or any job.
• The worker’s future earning capacity.
• The medical expenses associated with ongoing treatment.

While we remain in the early stages of workers comp coverage for job-related mental health claims, a baseline may be emerging: Writing on mental-health workers comp settlements, Richmond, Va.-based attorney Corey Pollard puts the customary range of PTSD settlements (without physical injury) from $50,000-$95,000, although he reports negotiating several six-figure PTSD settlements, up to $650,000.