Have you ever struggled with mental health issues that you believed stemmed from your job? Perhaps unrelenting stress, toxic management, or an unsafe environment took its toll over time. If so, you may have considered pursuing worker’s compensation to access treatment and take time to care for yourself without the fear of losing your livelihood.
Even though mental health injuries arising from one's job can be every bit as debilitating as physical injuries, proving and receiving benefits for these types of claims presents unique challenges. Keep reading to learn about psychiatric injury and common roadblocks to approval of psychiatric injury claims.
Psychiatric Injury
A psychiatric injury, also sometimes called a mental stress injury, is a type of emotional or mental injury that can be covered under the worker’s compensation laws. It involves particular psychological or psychiatric conditions that an employee develops or experiences as a direct result of their job, work environment, or conditions of employment.
Job-related psychological stress can lead to mental disorders, physical disorders, or both. State laws, like California’s, allow for worker’s compensation benefits for a wide variety of disabilities that result from mental stress experienced on the job. However, recent changes have made it more difficult (tightened eligibility) for employees to qualify for or receive benefits for disabilities related to job stress.
For instance, the psychiatric injuries caused by normal personnel actions are no longer eligible for compensation. The legal standard of evidence required to prove a mental stress-related claim (threshold of evidence) has also been increased. For a mental health condition to qualify as a psychiatric injury under California worker's compensation, it must meet the following criteria:
- The disorder must be diagnosed using the terminology and criteria of diagnostic manuals accepted in the field of psychiatric medicine, such as the DSM-III-R or other references approved nationally by psychiatrists.
- The employee must have worked for the employer for at least 6 months.
- Work-related events must be deemed predominantly responsible for causing the psychological condition.
Psychiatric injury cases are likely to result in expensive lawsuits. The costs associated with providing the required treatment, conducting medical evaluations, and paying out compensation benefits can be extremely high.
Barriers to Approval of Psychiatric Injury Claims
You should seek advice from a workers compensation attorney before submitting your claim, as this can ensure that any necessary forms are filled out correctly and all pertinent documentation and evidence are contained. Consulting a lawyer early on can help prevent the denial of psychiatric injury claims. The following are the common reasons why workers' compensation claims related to mental health issues get denied.
- Lack of Diagnosis and Insufficient Evidence of Causation
If the affected worker does not provide documentation and an official diagnosis from a qualified mental health professional, the insurance company may reject the claim due to lack of clinical diagnosis.
Secondly, establishing that the psychological injury was directly caused by events or situations at work can be difficult. Without solid proof connecting your mental illness to the job duties, the claim may be denied due to insufficient evidence of causation.
- Lack of Workplace Accommodations
Employers have a responsibility to make reasonable accommodations for employees with work-related mental health conditions. Consequently, if an employer fails to make necessary changes to support an employee or ensure a safe working environment, the insurance company could use this lack of workplace accommodations to deny the claim.
Endnote
Claims for workers' compensation regarding mental health issues can be challenging to demonstrate and can be rejected by insurance providers. By comprehending typical reasons such claims may be denied, employees can get themselves ready in a better way when initially applying for benefits or submitting an appeal if the first application is refused.
