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Workers’ Comp Programs and Injured Employees’ Mental Health

Offered by Law Offices of Richard A. Jaffe, LLC

As mental health care becomes more recognized as an important aspect of overall health, workers’ comp programs are getting more involved with mental health care in two ways:

  • More and more, employees are filing workers' comp claims that include, or are based on, mental trauma.
  • Benefits adjusters are recognizing the cost-savings of providing hurt employees with mental health care up front. Injured workers with related mental health issues often stay on workers’ comp longer, take more days to recover, and are more likely to return to restricted work duty.

Mental health on the job 

The link between mental and physical health is becoming a more accepted concept. Workplace mental health problems that can develop out of an on-the-job injury include:

  • Memory loss
  • Attention problems
  • Executive function impairment
  • Reasoning difficulties
  • Visual spatial dysfunction
  • Fear, stress, and anxiety disorders
  • Post-traumatic stress disorder (PTSD)
  • Phobias
  • Sleep disorders
  • Depression
  • Anger issues

Even so, it is not a given that an injured worker will have their mental health care needs met by workers’ compensation.

Who qualifies for workers’ comp?

Workers’ compensation insurance covers every employee for injuries sustained on the job. By law, your employer is required to pay 100% of the premium, and the benefit pays for the full cost of medical treatment; there are no out-of-pocket costs such as co-pays or deductibles. In addition, workers’ comp pays for partial replacement of your lost wages if you are unable to work for a period of time, as well as some additional benefits for permanent injuries. There is no waiting period for workers’ comp; you are eligible for these benefits on the first day of work.

Can I get workers’ comp for mental illness or distress?

Every state has different workers’ comp standards. When evaluating an injured employee’s request for mental health workers’ compensation, the Pennsylvania Workers’ Comp Bureau considers several questions:

  • Has the claimant’s psychological injury been objectively verified by an expert?
  • Can the psychological injury be traced to an identifiable source?
  • Did the incident, alone, and not any other comparable sets of incidents, lead to the employee’s mental injury?

If a workers’ comp claim passes this threshold, the applicant still has to prove the injury belongs in one of three recognized categories for mental health workers’ comp coverage.

Three types of workers’ comp mental health claims

Typically, a workers’ comp claim is due to a physical injury, but there is room in the statute for people to receive compensation due solely to mental trauma. In general, there are three categories of mental health injury recognized by the Pennsylvania Workers’ Comp program. Each one carries a different burden of proof.

Physical/mental injuries — These mental conditions develop during or after a physical injury. An example would be a worker who becomes depressed after being permanently disfigured. Getting workers’ comp for a mental component attached to a physical injury is usually straightforward – or at least no less straightforward than workers’ comp for a purely physical injury.

Mental/physical — There is growing evidence that poor mental health can lead to physical problems. Examples of a mental/physical injury include a stressful workplace that leads to an employee having gastrointestinal problems, like bleeding ulcers, or heart disease. Proving that your mental health was deteriorated by work — and not somewhere else — is a heavy burden for most injured workers.

Mental/mental — Workers’ comp claims based only on mental distress with no physical injury to the employee are rare, but not unheard of. For such a claim to be successful the employee usually, but not always, witnessed or was otherwise involved in a catastrophic event.

Proving mental health workers’ comp claims

Those are the three types of mental health injuries recognized by the Pennsylvania Workers’ Comp Bureau. Here’s the evidence required to prove them:

Physical/mental injury 

A common type of physical/mental injury is Post Traumatic Stress Disorder (PTSD), which causes the afflicted person to relive traumatic moments over and over. PTSD can be experienced by workers injured in accidents, victims of workplace violence, and so on.

An injured employee seeking physical/mental workers’ comp money must prove their poor mental state stems from a work-related physical injury.

Mental/physical injury 

To prove this injury, a worker must establish either:

  • Their mental health condition persists even when the person is not at work
  • Any resulting disability or loss of earning power is the result of the physical condition and not psychological trauma

Mental/mental injury 

Workers' comp will award people money for mental/mental injuries if they can prove that a single event, psychological trauma, or stressful working environment resulted in a mental condition. To do that, an employee must show one of two things caused the trauma:

  • An extraordinary event at work that can be pinpointed to a specific time and date
  • Longtime exposure to abnormal working conditions. Courts have upheld mental/mental awards for people who were sexually harassed or had their pay checks stolen at work. Even people with traditionally stressful jobs may qualify for compensation if they were mentally injured by a distinct and unusual situation.

Get legal help with workers’ comp claims

Researchers are increasingly finding links between physical and mental health and that having one without the other can lead to new or worsening conditions. This means that having mental health coverage included in workers’ comp claims is critical protection for injured workers.

But change is slow and plenty of stigma exists about mental health care in the U.S. For an injured worker, proving a work-related mental health injury exists and is worthy of additional compensation is often an uphill battle.

An injured employee’s best chance at getting the most out of their workers’ compensation claim, especially for mental injuries, is to contact a local lawyer who puts the needs of hurt workers first. A knowledgeable workers’ comp attorney with decades of experience can navigate the pitfalls and pathways of the workers’ comp system.

Incorrectly filling out a form, checking the wrong box, or missing a date can be enough to ruin an entire workers’ comp claim. A reputable workers’ comp lawyer can file the right applications to the right people and at the right times. They can handle calls from insurance adjusters and investigators and conduct their own investigation into the accident. A workers’ comp lawyer can negotiate with the bureau to get their clients the most compensation possible. If necessary, they can also file a rejection appeal.

Workers’ comp lawyers provide free case consultations to potential clients. During the session, an attorney will listen to the details of your case and help you understand how the law applies specifically to you. If you are filing or considering a workers’ comp claim, contact a local workers’ comp lawyer for a free evaluation now.

The Law Offices Of Richard A. Jaffe, LLC is a workers’ compensation law firm in Philadelphia, PA.

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The Law Offices of Richard A. Jaffe, LLC is dedicated to providing compassionate, comprehensive Workers’ Compensation and Social Security Disability (SSD) representation throughou...