Does Workers’ Comp Cover Mental Health Conditions in CA?
While workers’ comp benefits are generally associated with physical injuries sustained in the workplace, some states extend workers’ compensation to employees suffering from mental or emotional injuries as a result of workplace-induced trauma or occupational duties. California workers’ comp laws recognize that psychiatric conditions can stem from an employee’s occupational duties, meaning that certain disorders and symptoms are considered compensatory in workers’ comp claims.
Keep reading to learn more about applying for workers’ compensation benefits after suffering a psychiatric injury in a California workplace.
Workers’ Compensation for Mental or Emotional Injuries
A psychiatric injury is an emotional or mental injury under California workers’ comp laws. It entails any form of psychological or emotional damage that an employee suffers as a result of their occupation or workplace environment, such as post-traumatic stress disorder (PTSD), anxiety, or major depressive disorder.
Under California Labor Code § 3208.3, a psychiatric injury must fulfill the following criteria to be considered an acceptable ground for workers’ compensation:
- The psychiatric condition is listed in the DSM-IV
- The employee has been employed for a minimum of 6 months
- Actual employment events are at least 51% responsible for causing the condition
Proving Psychiatric Injuries in Workers’ Comp Cases
For a psychiatric injury to be considered compensable, there must be proof that the disorder resulted from the employee's work situation or environment, as such injuries are treated differently than other physical trauma incurred on the job under California workers’ compensation laws.
To successfully prove that a psychiatric injury is work-related, California workers should keep the following elements in mind:
Unlike physical injuries, which need only demonstrate that they are related to the workplace to be compensated, psychiatric injuries must also show direct causation between the condition and an event or circumstance at work. Most workers' compensation insurers also require additional evidence, such as diagnosis reports from a qualified mental health professional or other licensed provider to successfully establish coverage for psychiatric injuries.
Workers applying for workers’ comp due to psychiatric injury must also provide evidence demonstrating a clinical diagnosis of the disorder. The diagnosis must come from a licensed mental health professional and clearly state that symptoms are consistent with the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A proper diagnosis will include details regarding how long symptoms have been present and what level of interference they are causing in daily functioning.
Finally, it's important for individuals filing a workers' comp claim for PTSD to keep detailed records of all expenses related to medical treatment for their condition. These documents can include items like invoices from medical professionals or practitioners involved in providing care, receipts related to medication costs, transportation fees associated with attending doctor’s appointments, or any other out-of-pocket costs incurred as part of receiving treatment for PTSD.
3 Reasons Why Psychiatric Workers’ Comp Claims Get Denied
Workers' comp claims related to mental health conditions, such as PTSD, can be difficult to prove and are often wrongfully denied by insurance companies. By understanding common factors leading to the denial of workers’ comp claims related to PTSD and other mental health conditions, workers can better prepare themselves when applying for benefits or filing an appeal if their first application is unsuccessful.
It’s crucial for applicants to consult with a workers’ comp lawyer before filing their claim, as this can ensure that the required forms are filed correctly and all necessary documentation and evidence are included. Common reasons why workers’ comp gets denied for mental health disorders include:
- Lack of Clinical Diagnosis – Insurance companies may deny a claim when the injured worker does not provide proper documentation from a qualified mental health professional. A diagnosis must meet the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to be considered valid for workers' compensation purposes.
- Insufficient Evidence – Establishing causation between an event or circumstance in the workplace and the development of a psychological injury is key in obtaining workers' compensation for mental health disorders. However, it can be challenging to provide sufficient evidence that connects the employee's condition directly to their job duties or environment. Without adequate proof, an insurance company may deny a claim due to a lack of causation between work and mental illness.
- Lack of Workplace Accommodations – Employers are responsible for providing reasonable accommodations for employees diagnosed with mental illness due to work-related events or creating a safe working environment for them to remain productive and healthy members of the workforce. If an employer fails to make these necessary changes, then their insurance company may reject a workers' comp claim relating to psychological injury resulting from work-related circumstances.
Passionate Representation for Injured Employees in CA
Being injured in the workplace can lead to financial and emotional stress in the lives of California workers, which is why Alvandi Law Group is here to help. Our dedicated workers’ compensation attorneys exclusively represent employees and have recovered over half a billion dollars on their behalf, making our firm a trusted name for workers’ comp matters throughout the Golden State.
With over 75 years of combined experience, you can trust our compassionate legal advocates to help you navigate the legal intricacies of your workers’ comp case without losing sight of your personal goals. From filing a claim to appealing the wrongful denial of workers’ comp benefits, our experienced legal team can fight for the compensation you rightfully deserve.
Our firm exclusively represents injured workers in California. We can fight for the compensation you deserve. Call (800) 980-6905 to schedule a free consultation.