CLAIMS AND STRESS CLAIMS
In California, a worker
can receive workers’ compensation benefits for a psychiatric injury if
the worker can prove the following:
The worker has a
psychiatric diagnosis listed in a book called DSM IV. “Stress” alone,
is not enough.
The worker was employed
at least six months (certain very limited exceptions apply)
The actual events of
employment are the predominant cause (50%+) of the psychiatric
condition. (Certain limited exceptions apply). This means that the
employer/insurance company can ask you questions about your entire
personal life from the date your were born. You waive most of your
rights to privacy for these sensitive matters when you pursue a
condition is not substantially caused (35% to 45%) by a good faith,
lawful, non discriminatory personnel action. (The burden of proving
this rests with the employer)
The employee reported
the injury prior to termination or notice of termination.
If the employee did not
report the injury prior to termination, the medical records of the
employee show treatment for the psychiatric condition prior to the
termination. This does not apply if the psychiatric condition is
caused by a physical injury that was reported before the termination
or where there are records of treatment for the physical injury prior
to the termination.
The result of several
waves of workers compensation reform beginning in 1989 has been to
make recovery for many psychiatric injury claims very difficult in
MENTAL – PHYSICAL CLAIMS
Psychiatric claims that
are caused by a serious physical injury or physical condition(s) are
known as Mental-Physical Claims. Often, a serious physical injury
impacts other aspects of an injured workers’ life. Examples of such
impacts are sleep disorders, depression and/or anxiety caused by the
physical pain, diminished functional ability, and the loss of an
injured workers’ profession.
Under the new permanent
disability rating system, if you have a serious physical injury that
results in your having significant impairment in your activities of
daily living, or you are experiencing chronic pain or sleep
disturbance, you need to have your psychiatric general assessment of
functioning (GAF) considered. This is more important than ever
because the new permanent disability rating schedule dramatically
short changes those with serious objective physical injuries (contrary
to what was promised by Governor Schwarzenegger when SB 899 was signed
It should be noted that
in California, psychiatric injury caused by job termination, the
emotional reactions to the claims process (i.e. being cut off from
benefits, receiving an unfavorable decision, etc.) are not eligible
MENTAL – MENTAL CLAIMS
Almost all Mental-Mental
(Psychiatric or stress claims that do not also involve a physical
injury i.e. Mental-Physical) are denied. Most of these cases are also
lost at trial due to the good faith personnel action defense.
A Mental-Mental claim
that is caused by being the victim of a crime at work, witnessing a
sudden violent event, or being the victim of sexual harassment may be
a viable mental—mental claims.
Claims by short term
employees (Less than two years) that do not involve the above events
above are usually weak claims.
Claims that involve
conflicts with supervisors or perceived unfair treatment at work are
almost always weak claims.
This office takes very
few mental-mental claims.