Appealing a Denial for Psychiatric or Psychological Claims

Job-related injuries can have long-lasting impacts, even beyond the physical injuries. A traumatic injury can cause anxiety, depression, and other mental injuries. Getting the mental health care necessary to recover is challenging. Some employers try to deny psychiatric medical care claims for workers’ comp cases.

Workers’ compensation laws differ depending on where you live. Talk to a local workers’ compensation lawyer for advice on appealing a workers’ comp denial for psychological injuries.

Challenges of Psychological Workers’ Comp Claims

Workers’ compensation claims involving psychological injuries are more challenging than physical injury claims. Some states don’t cover mental-only work injury claims. Other states only allow mental injury claims for first responders with PTSD. For many workers, psychological injury claims are only covered if they accompany physical injury.

Proving the injury is also difficult for psychiatric injury claims. Mental health injuries don’t necessarily leave obvious marks like physical injuries. Even after a patient thinks they have fully recovered, mental effects can take time to develop. An injured worker may develop mental health problems months after the workplace injury. It’s important to get professional medical attention, including mental health care.

If the insurance company denies your disability claim, talk to a workers’ comp lawyer. A workers’ comp lawyer can review your denial and file an appeal. You have a limited time frame to appeal a denied claim, and you could lose benefits if you wait too long. A lawyer can help you gather evidence to support your claim and get the workers’ compensation benefits you deserve.

Workers’ Comp Claim Appeals Process

Many injured workers have their insurance company deny treatment for mental health conditions. The insurance company can deny your mental injury workers’ comp claim for many reasons. Some denials involve clerical errors, unreported accidents, or not filing a claim on time. Common reasons for denying psychiatric injury workers’ comp include:

• The injury was not work-related
• The worker isn’t disabled and can return to work
• The mental illness was a pre-existing condition

To deny the claim, the insurance company may require an independent medical examination (IME). The independent examination is generally from a health care provider who isn’t your treating doctor. If the independent review doesn’t find psychiatric care necessary, the insurance can deny your medical treatment.

In most states, you have a chance to review the doctor’s report and request an appeal or get a second opinion. If the workers’ compensation insurance company denies your claim, they have to tell you why. In some states, you can file an appeal with the workers’ compensation board.

The appeals process varies by state. Talk to a workers’ comp lawyer about the legal process for appealing a denied claim.

Gathering Medical Evidence for Psychiatric Claims

You need supporting evidence to prove your psychiatric injury relates to your workplace accident. Medical evidence and expert testimony can show how the accident caused your injury. Supporting workers’ comp evidence to support your mental injuries can include:

• Medical records
• Medication records
• Accident reports
• Witness statements
• Medical bills
• Out-of-pocket expenses

Your lawyer can help you gather records to support your claim. Your lawyer can also review your claim denial letter to identify what evidence is missing. They can work with your doctors to get the right evidence to support your workers’ comp claim.

Working With Mental Health Professionals in Workers’ Comp Claims

Generally, injured employees need a clinical diagnosis from a licensed mental health professional. In some states, qualifying mental disorders have to be listed in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM). Examples of qualifying mental health disorders include:

• Substance use disorder
• Post-traumatic stress disorder (PTSD)
• Anxiety disorder
• Depression
• Panic disorder
• Specific work-related phobias

A qualified expert can testify about your diagnosis as a psychiatric or psychological injury. They can give their expert opinion about the cause of your mental health condition. Medical experts can also testify about how your symptoms interfere with your work duties and daily living.

Legal Advice for Workers’ Compensation Appeals

Dealing with health insurance companies after a work-related injury is frustrating. You should focus on getting the care you need so that you can recover and get back to work. A workers’ comp attorney can give you legal advice and support during the claims process.

Your lawyer can explain your options and represent you to protect your legal rights. Speak with an experienced workers’ compensation attorney for help appealing a psychological injury claim.