In the early 1990’s when many states began passing workers compensation insurance acts, there was a prerequisite that any compensable injury had to have a physical impact. That has changed over the years.
Today most states accept that mental injuries can occur and, therefore, can be classified as a compensable injury. Mental injury workers comp claims can be expensive to defend, and expensive if found to be compensable.
3 Types of Mental Injury Cases Affecting Workers Compensation Insurance
Pennsylvania workers compensation law distinguishes between three (3) types of mental injury cases:
- Mental / Physical
A work-related mental or emotional experience causes physical consequences. Sometimes a heart attack or cardiac condition can qualify as a compensable event under this standard. In this case, most courts apply a two-part test. The first part is the need for an accumulation of workplace stress beyond the ordinary day-to-day stress employees are exposed to. The second part is the need for legal causation between the stress and the alleged work injury. - Physical / Mental
A physical stimulus causes a mental injury. A good example of a “physical/mental” case involves an amputation or orthopedic injury of sufficient severity to necessitate later psychological counseling or psychiatric treatment for a condition such as depression or PTSD. Although the physical injury need not be the only cause of the mental injury, the element of “contact” is required. - Mental / Mental
A mental or emotional stimulus causes purely emotional sequela (an aftereffect of a disease, condition, or injury). There is no physical impact or harm. This applies to any employee that is subjected to “abnormal working conditions.” Typically a verbally abusive boss is not sufficient grounds, but a store clerk who has been robbed at gunpoint, is traumatized by the event, and can no longer function normally may be.
The categorization determines the burden of proof. In physical/mental and mental/physical cases, the claimant needs to provide evidence that establishes that his or her injuries arose in the course and scope of employment. Mental/mental injuries require a higher burden of proof. The Claimant needs to demonstrate the presence of “abnormal working conditions.”
Proper Handling of Workers Compensation Insurance Claims
In addition to understanding the laws in your state regarding mental injury workers’ compensation claims, you also need to learn how to work with medical experts. Here are three tips when choosing and working with medical experts.
- Prior to the independent medical/psychological evaluation by your medical expert, provide a complete set of medical records - including review of all pre- and post- injury medical records related to the employee’s conditions - if you want your expert’s opinions to be accepted.
- You never know how a court may respond to a medical expert. It may accept your expert’s opinions based on a rational explanation that the employee’s condition is affecting their recovery or they may be more receptive to the medical expert’s opinion when the report is detailed and supported by deposition testimony. Therefore, provide a detailed and logical explanation for an expert’s opinions to help prove your theory or position.
- Accurate and concise reporting is essential when it comes to the acceptance of an expert’s opinions. If your expert makes the slightest error or omission, all of his opinion could be disregarded.
Learn More About Your Workers' Compensation Insurance Options
To learn more about saving on workers’ compensation insurance costs and all your workers comp insurance options, click here to contact American Insuring Group or call us at (800) 947-1270 or (610) 775-3848.
