Most people know that workers compensation in California covers numerous physical injuries and illnesses sustained on the job. This coverage applies to sudden injuries and accidents as well as conditions that developed over an extended period such as carpal tunnel syndrome. What many people do not know is that existing legislation also covers psychiatric work injuries in addition to physical ones.
These claims can be much harder to prove, both because of the nature of the illness and because of its effect on a person’s life. It can be difficult to file the right paperwork and keep track of deadlines when coping with a severe mental health challenge. Employers also tend to challenge these claims more frequently, demanding a larger volume of paperwork and medical documentation before the claim can be approved.
Learning more about psychiatric work injuries as well as workers compensation claims can help make the complicated field a bit easier to navigate. Knowing in advance which forms your doctor needs to complete, for example, can also speed the process up. This information can also guide you in making your decision about whether you need to hire a lawyer.
What is a Psychiatric Work Injury?
A psychiatric work injury happens when an employee suffers mental injuries as a result of their working conditions. Most psychiatric injuries develop slowly, over time. Examples include an employee suffering from a mental breakdown after being overworked or develops a panic disorder after being subjected to constant workplace harassment or abuse. These events can wear a person down, to the point of diminished mental health. As a result, the employee may be unable to perform workplace tasks or may need significant time off work.
Most benefits received as a result of these types of claims are temporary and limited. While benefits are available, allowing the individual the time to seek and receive appropriate treatment, obtaining permanent benefits is much harder. The assumption is that once the employee has an opportunity to receive treatment, they can recover.
California Labour Code 3208.3 governs the requirements a psychiatric injury must meet if it is to qualify for benefits. In addition to the employee’s obligation to seek out psychiatric services, these seven other qualifications must be met:
- The employee must have worked for the employer for at least six months
- The employee must be diagnosed with an illness listed in the most recent version of the Diagnostic Statistical Manual of Mental Disorders
- The onus is on the employee to prove that the condition was primarily caused by the events of employment (i.e., at least 51% of the illness must be the result of employment, not other circumstances)
- Conditions caused by good faith actions or decisions made by supervisors and members of management, such as criticism of work performance, changing in the type of work assigned, and decisions about potential raises or promotions are not considered work-related injuries. For a claim to be defeated on these grounds, the onus is on the employer to prove that the injury was the result of those good faith actions
- If the condition is caused by a related litigation process, it is not covered by workers compensation benefits
- Any type of claim filed after the termination of an employee is not covered, unless the employer was aware of the employee’s injury or treatment for that injury prior to termination
- Stress alone is not considered a psychiatric condition and is not covered by workers compensation
To show that you are mitigating your damages, you should provide proof that you are regularly attending therapy or some type of therapeutic treatment for your psychiatric injuries. It is advisable to have your doctor provide you with an updated record of visits after each appointment, so you can provide this information to the employer or their insurance company upon request.
Make sure to keep track of any therapeutic treatment options recommended by your doctor, including neurofeedback, medications, support groups, and even exercise. Workers compensation does provide funds to employees for treatment options such as these, so be sure get an updated list from your doctor. If medications are prescribed, the insurance company may also want proof that they are being taken as recommended, making pharmaceutical records another important item to request at each visit.
What Different Types of Claims Exist?
There are two types of psychiatric claims recognized under current California law. The type of claim filed depends on the extent and nature of the injuries sustained.
Mental-Physical Claims – these types of claims involve psychiatric injuries that happened as the direct result of a physical injury causing pain, diminished functional capacity, or a job loss due to a workplace injury. Many mental-physical claims involve disorders such as depression, panic attacks, and sleep disturbances, as well as a physical component.
Mental-Mental Claims – these types of claims occur independent of a physical injury. They typically occur to individuals who have witnessed or experienced a traumatic event while on the job, including violence, sexual abuse, or physical assault.
Mental-physical claims are often more successful than mental-mental ones, most because it is much easier to prove that a mental injury was sustained at work when it is paired with a physical one. For example, it may be hard to prove that depression alone was caused as a direct result of a work-related incident. However, when depression is coupled with a back injury and pain issues, it is easier to prove that the mental injury was caused by a work-related situation. It is quite common for individuals with back pain to suffer from depression, connecting both injuries to the workplace.
In most cases, the appropriate claim to file is obvious. However, there may be situations where it is unclear which one is the best. Filing the wrong claim can result in rejection, making it harder to get the funds you need for your treatment. If you are confused or have questions, consult with your doctor to get their opinion on the nature and extent of your injury. You may also want to speak with a lawyer at this stage.
What Options Are Available?
If you have suffered from a work-related psychiatric injury, you have two options available to you for seeking compensation. The first is to file a workers compensation claim. If you need the qualifications listed above and you, your doctor, and your lawyer believe your claim may succeed, this could be the best option for you. Filing workers compensation claims is not incredibly costly. Even if you hire a lawyer to provide guidance and assistance, their fees for these services are usually quite reasonable.
The second option available is to file a lawsuit against your employer. Lawsuits may be your only course of action if you fail to meet the above workers compensation requirements. It is also an option if you want to pursue your employer for punitive damages in addition to medical compensation.
It is important to note that you cannot pursue both actions simultaneously or consecutively. If you decide to sue your employer, you are precluded from filing a workers compensation claim. Conversely, if you opt to file a workers compensation claim, you cannot then sue your employer. Deciding which one is the best course of action depends on the unique details of your individual case. You may want to think about your chances at success with either option, whether or not you meet the qualifications listed above, the amount of settlement you believe is reasonable, and how much money and time you want to invest in your claim.
What is Covered by Workers Compensation?
Workers compensation covers several expenses, including:
- Medical care, therapy, and medications
- Wage replacement
- Any expenses involved in retraining if you need to switch careers
Income received from wage replacement is not taxed and begins almost immediately. It is typically calculated at two-thirds of the employee’s wage. These benefits are retroactive, so if you are unable to file immediately you do not lose your wages for those early days off.
Workers compensation does not cover punitive damages, or any amount for pain and suffering on the part of the employee or their families. This is why it is important to carefully consider which compensation recovery option is best for you before pursuing one. Consulting with a lawyer can help make this decision much easier. They are familiar with the system, thanks to their years of experience in the field.
What Documentation is Required?
It is important to remember that claims of this nature are scrutinized by employers and insurance companies much more heavily than claims for physical injuries alone. Consequently, you should gather together as much documentation as possible. Start by thinking about the origins of your psychiatric injury and compiling anything that points to your workplace as its cause. This may include things like emails as well as witness testimony from anyone who may have knowledge of the events leading to your injury.
You also need to provide documentation about your medical history, including your mental and physical health records. Insurance companies may also request information about the circumstances of your life, including your family arrangement, any litigation you may have been involved in, your criminal record, and financial documents. It is a good idea to get your doctor involved in your claim as early as possible, to give them time to prepare and gather the necessary medical records.
While you should have this information handy, there are certain documents you do not need to provide until requested. Others you should volunteer as they might be helpful for your case. Distinguishing between these types of records can be difficult for someone who is not familiar with workers compensation claims. Consider hiring a lawyer to provide their assistance and expertise, ensuring that you file all required, appropriate, and helpful documents when necessary.
Some people may feel uncomfortable turning over information about their medical history or financial records. Unfortunately, current legislation allows insurance companies to make these requests. Failure to fulfill them on the part of the employee almost always results in a claim denial. If you are feeling nervous about handing over documentation like this, consider hiring a lawyer. They can work with the insurance company, ensuring they only receive the documents they need to prove or disprove your claim. They can also speak with you on an empathetic level, helping you to understand why the information is necessary, and providing reassurances about its use.
Since most psychiatric work injuries do not present with visual symptoms or signs, proving that such an injury exists is very difficult. For this reason, most claims are initially denied. Claims are also routinely denied if the paperwork is not completed properly or filed by a certain deadline. Additionally, you may be uncertain about which option is best for you: filing a claim or suing your employer. Trying to make these decisions on your own is incredibly stressful, especially if you are unfamiliar with workers compensation law.
Contact an Experienced Psychiatric Work Injury Attorney
If you are suffering from a psychiatric injury sustained on or because of your job, your first step should be to contact an experienced and skilled workers compensation lawyer. These individuals can consult with you early on, helping you decide which compensation option is most likely to succeed given the unique facts of your situation. Regardless of which course you take, they can be with you each step of the way, ensuring that no deadline is missed, and all paperwork is completed properly.
Hiring a lawyer takes a lot of stress out of the claims process, which can be a huge relief for a person suffering from a psychiatric work injury. Lawyers also have a professional obligation to do their best on your behalf, giving you peace of mind in knowing that your claim is being handled in the best possible way.
If you are in California, you can contact Orange County Workers Compensation Attorney to learn more about your case. They have years of experience in the field, providing compassionate yet effective legal services to numerous clients throughout the state. Workers compensation claims are their specialty, so you know that your matter is in good hands. Each member of their office is empathetic and understands the challenges faced by someone dealing with this type of sensitive claim. Contact one of their friendly administrative professionals at 949-423-3212 to book your consultation today.