If you are suffering from a mental condition or have been dealing with emotional distress, you may be wondering if you’re covered by workers’ compensation. You can file a claim if you work in California and suffer a psychiatric injury.
Getting Compensated for a Mental Health Condition
California adds psychiatric injuries to the worker’s compensation system. However, insurance companies and employers do refuse workers comp claim requests for anxiety and depression. As a result, employees with psychiatric injuries often have a harder time proving their emotional or mental condition is related to their job.
However, research suggests, there is a real tie-in between productivity and psychiatric illnesses that result from working. For instance, presenteeism represents a circumstance where an employee is symptomatic but stays at work despite the fact they are not as productive as other employees.
Moreover, many workers come into work with symptoms that resemble a physical illness. However, their symptoms are more strongly suggestive of a psychiatric malady – something that developed over time – slowly but surely.
Other research shows that depression has the greatest negative effect on productivity and is equal to rheumatoid arthritis when it comes to completing tasks.
Qualifying for Psychiatric Workers Comp Benefits
Because the worker’s compensation system in California will support the claims for stress-induced illnesses, the following criteria are used for legitimizing claims.
- An applicant must show that they have a specific psychiatric injury, as featured in the Diagnostic and Statistical Manual of Mental Disorders or DSM-V.
- An applicant must also prove that their tasks, or their work environment, led to a psychiatric condition. This standard is lowered if an employee experienced workplace violence.
- Employees must prove, as well, that any actions taken by Human Resources (HR) in good faith, such as issues with punctuality, attendance, or job performance, were the cause of the condition.
- Employees must work in their job for at least six months unless the claim involves an “extraordinary” event.
When filing a workers comp claim, it’s important to remember that stress in and of itself is not considered a psychiatric condition. Stress, instead, is defined as a symptom of a condition that has been diagnosed.
Examples of diagnosed conditions include post-traumatic stress disorder, clinical depression, or anxiety disorder.
Talk to a Workers Comp Attorney Before You Do Anything Else
If you’ve experienced substantial stress in your job – to a point where you cannot perform some of your work duties, you need to speak to a workers comp lawyer now. Ask the attorney to explain your rights with respect to workers’ compensation benefits.
Even if you were terminated from your job, you may be able to file a worker’s compensation claim for a work-related psychiatric condition.
You’ll Need to Support Your Claim with a Doctor’s Testimony
Psychological injuries under the worker’s compensation law in California must be filed with the supporting testimony of a doctor. The doctor must relay the information in a form that is backed by a patient’s medical history, job history, workplace conditions, and level of job satisfaction.
Doctors should reinforce their testimony by submitting supporting items like medical records and lab data,
When a work injury is considered psychological, it is called a mental-mental claim or stress claim. In other words, the employee has a mental or emotional condition because of the stress they are under at work.
Psychological injuries often force employees to take time off or experience problems when performing work-related tasks, especially when it comes to focusing or communicating with other employees.
Two Underlying Causes for Psychiatric Injuries: Overwork and Workplace Threats
Some employees who file workers comp are severely overworked – to the point of exhaustion. If an employee is subjected to threats during the workday, they may also file a claim for a psychiatric workplace injury.
Because a doctor cannot use objective tests–like blood testing or an x-ray–to measure the severity of a psychiatric injury, workers comp claims can be hard to verify.
In addition, it’s difficult to report a psychiatric work condition, as the psychiatric injuries of employees may have nothing to do with the work itself, but may be triggered by a personal reason.
Accepting a Claim: What Workers Must Show
When filing claims for psychiatric injuries, employees must follow the tips below to show they have a bona fide work-related mental or emotional illness:
- Claimants must show their mental condition was diagnosed per accepted and proven procedures.
- The worker must show they required medical treatment or experienced a disability (or could not perform some tasks) because of the injury.
- The employee must show they have been employed for six months unless their injury led to an extraordinary work condition that surfaced suddenly.
- Claimants must demonstrate that the actual conditions of employment are the main reason for the worker’s injury, with the working conditions being at least 51% attributable to the illness. The standard lowers to 35% to 40% if the employee’s psychiatric condition resulted from workplace violence or they were exposed to substantially violent action.
An employee’s personal life may be reviewed, as well after claim submission. Examiners may assess a claim by checking on personal details. A filer’s- financial troubles, family history of mental illness, family problems, criminal background, or past or current drug abuse may be placed under scrutiny.
Actual Events of Employment
Another hurdle to jump when filing a worker’s compensation claim is whether your condition results from an actual event of employment. For example, a psychiatric injury cannot be based on an employee’s anxiety over their company’s financial condition or the fact they may experience downsizing.
Other Reasons Why Workers Comp May Deny Your Claim
Your claim may also be denied if your employer shows that nondiscriminatory human resource activities, such as a fair criticism of your on-job performance or denial of a promotion, largely contributed to your psychiatric injury.
An Extraordinary Workplace Event
Insurers may also issue a denial if an employee filed the claim after being fired or laid off. Unless the employee can show that the illness resulted from an extraordinary workplace event, any stress resulting from a firing or layoff is not an acceptable reason for filing a claim.
An injured worker may receive psychological compensation under the state’s workers’ compensation six-month rule according to the California Workers Compensation Appeals Board. These types of incidents can lead to psychological distress, thereby compounding the injury.
Contact a Worker’s Compensation Lawyer About Your Work-Related Psychiatric Condition Now
Do you have a question about a psychiatric injury that is work-related? If so, you need to discuss your case with a worker’s compensation attorney. In California, discuss your case with Workers Comp Lawyer LA, Belal Hamideh Law, PC today.
