If you're an injured worker, you might be undergoing a ton of stress due to your physical injury. All of this is completely understandable. Your source of income has gotten cut. Meeting monthly expenses has become difficult. The physical pain might be unbearable. Your Work Comp claims administrator might have treated you with less than respect. Your recommended treatment might never get authorized. Your claim has dragged on forever. You're looking at going to trial over your claim.
And then there are cases where bosses and/or coworkers are such bullies that going to work is what's the issue. The constant teasing, harassment, passive-aggressiveness, or outright disrespect wears down on you, but the job market is so terrible that you can't "just" find a new job. You wake up each workday with a sense of dread. That dread may have started physically manifesting into digestive issues, migraines, or back pain. You've gone as far as to look up your symptoms on WebMD and think you have clinical anxiety or depression from your job. Or perhaps you're proactive and already seeing a psychologist and want to know whether someone else should be footing the bill, like Work Comp insurance.
There must be some kind of remedy for all of this, right? Not terribly much, at least as far as Workers' Compensation is concerned.
It's Very Difficult to Meet the Requirements of an Emotional Stress (Psyche) Claim
Recent legislative changes has reigned in psyche claims. The law still mandates that employers be responsible for an employee's psychological problems, but those problems must satisfy all of the following:
Proving all of the above can be very daunting. For instance, defining what are "actual events of employment" is complicated. The courts deem taunts and interpersonal problems with a supervisor as possibly compensable, but the courts deem a psychiatric injury arising out of the Work Comp litigation process as too tenuous to employment to be compensable. For instance, being upset over a doctor's report or experiencing any other "litigation neurosis" is not compensable.
Further complicating matters is the caveat that if an injured worker experiences aggravated injuries due to certain traumatic events occurring from the Work Comp litigation process, then those injuries are compensable as part of the original industrial claim. For instance, a court allowed compensation for aggravated injuries when an overzealous claims administrator committed acts that constituted a civil tort of "intentional infliction of emotional distress."
The law also affords employers a defense against psyche claims for making non-discriminatory, good faith, personnel decisions. These decisions include transfers, demotions, layoffs, and disciplinary actions.
Proving Your Stress Claim Can Feel Like an Invasion of Privacy
Another issue of possible contention is how doctors determine to what extent an employment event contributed to your stress. With some exceptions, the event must have been at least 51% responsible for the claimed psyche issues, and it's difficult to say how exactly a psyche doctor can scientifically determine what's work-related. In the evaluation process itself, however, a psyche doctor can inquire as to any past or current psyche issues and get treatment records to make that determination. The process can therefore feel very invasive, especially because the psyche doctor will write a report that may reveal reveal past psyche issues that would have otherwise been private information under HIPAA.
Workers' Compensation Provides Limited Benefits for Psychiatric Claims
After some legislation passed in 2013, psychiatric injuries will no longer attribute to any permanent disability rating and payout except in "catastrophic cases." More specifically, this new legislation means that if an injury causes sleep dysfunction, sexual dysfunction, or a psychiatric disorder, any of those issues will not increase an injured worker's impairment rating towards receiving a permanent disability award. While an injured worker can receive medical treatment for these issues, there are a number of reasons why seeking treatment under the Workers' Compensation system may seem less than desirable.
The Exception for Catastrophic Cases
Psyche claims that arise out of what's called a "catastrophic injury." The law defines this as being a victim of a violent act, being directly exposed to a significant violent act, or suffering from a catastrophic injury. The latter includes the loss of a limb, paralysis, severe burn, or severe head injury.
With a catastrophic case, an injured worker may obtain medical treatment and possibly a permanent disability award.
That all being said, we do not at all discourage the filing of psyche claims. There have been instances where we've found very legitimate psyche claims apart from those involving catastrophic cases, and only wish to admonish people that psyche claims can be difficult to prove and possibly more invasive than most people would like. The compensation is also limited. Unlike what people assume comes with "pain and suffering" (money award), filing a psyche claim will typically only garner an injured worker with a claim for medical expenses related to the psyche injury.