Workers' Compensation and Mental Health Claims

Many employees deal with workplace stress that can cause mental health damage. Workers with severe mental health conditions can find it challenging to do their jobs. When the job causes mental illness, you can file a workers’ comp claim. A workers’ comp claim can help you get medical treatment and benefits while you’re out of work.

Mental health workers’ comp claims can depend on state laws. To find out about filing for benefits in your state, talk to a local workers’ compensation lawyer.

Work-Related Mental Health Injuries

People generally think of physical injuries when they think about workplace injuries. However, you can also suffer mental health conditions related to your job. Work duties can cause or aggravate mental health conditions that make it difficult or impossible to do the job. Workers’ compensation provides injured workers with medical and wage loss benefits.

To qualify for workers’ comp for mental health conditions, you have to get a professional diagnosis. Get diagnosed by a qualified medical specialist. If you are eligible, you can continue to get benefits until you can return to work.

Legal Rights of Employees With Mental Health Conditions

According to the National Institute of Mental Health, more than one in five Americans live with a mental illness. These include mental, behavioral, or emotional disorders ranging from mild to severe.

Workers’ compensation laws vary by state. Some states are much better at protecting people suffering from work-related mental conditions. Other states limit which conditions qualify and how much you can receive in benefits. State laws can also determine the initial choice of treating physician by the employer or employee.

For example, California requires you to work at least six months to claim cumulative mental stress injuries. Psychiatric stress impairments from normal personnel actions do not qualify. In Pennsylvania, a worker has to prove they sustained a mental injury because of an abnormal condition in the workplace.

A number of states don’t include mental disorders unrelated to a physical injury. States may only include mental injury claims from repeated trauma at work and not a single traumatic event. For information about your legal rights after a work-related mental health condition, talk to a local workers’ comp lawyer.

Types of Mental Health Issues Covered

Mental health conditions that qualify for workers’ comp can depend on state law, the type of condition, and the job duties. Examples of qualifying mental health conditions include:

• Depression
• Anxiety disorders
• Post-traumatic stress disorder (PTSD)
• Opioid use disorders

Some workers can get benefits for a pre-existing condition that delays recovery from a work-related injury or illness.

Some states have specific laws for specific types of workers. First responders are more likely to suffer psychiatric injuries on the job. After the COVID-19 pandemic, many states expanded workers’ comp laws for first responders. These states have made it easier for police officers, EMTs, and firefighters to get care for post-traumatic stress injuries.

Proving a Workers’ Comp Mental Health Claim

Different states have different processes for approving mental health workers’ comp claims. It may depend on whether the mental injury accompanies a physical injury or not.

Generally, you must have a diagnosis from an appropriate medical or mental health professional. Licensed physicians can diagnose traumatic mental health injuries. Psychiatrists or clinical psychologists can diagnose mental occupational diseases.

Your doctor should include a history of your work exposure and previous conditions and treatments. The doctor should also detail their findings, including how your work exposure caused your condition.

Your workers’ compensation board can deny your claim or request more information. You may have to submit additional evidence, including:

• Witness statements
• Email records
• Medical records
• Mental health records
• Employer correspondence

If the workers’ comp board declines your claim, you can file an appeal or request for reconsideration. There’s a limited time to appeal your claim. If you wait too long, you can lose out on getting workers’ comp benefits. Talk to a workers’ comp lawyer as soon as possible to make sure you file your case in time.

Common Challenges in Mental Health Workers’ Comp Claims

The most common challenge for workers with mental health work injuries is having the insurance company deny the claim. The workers’ compensation insurance provider can deny a claim they think is not work-related. You then have to go through the appeals process to get your benefits.

Another challenge involves disclosing your personal mental health to your employer. When you file a mental health workers’ comp claim, you have to disclose your psychological conditions to the insurance company. However, there are confidentiality restrictions for mental health conditions. Employers can suffer civil penalties for revealing information about your mental health condition.

Tips for Navigating the Claims Process

Navigating the workers’ comp claims process is difficult. You may have to deal with denied claims and fight to prove your working conditions caused your mental illness. A workers’ compensation attorney can represent you in disputes with the insurance company. They can explain what types of claims qualify and how you can get workers’ compensation coverage.

To protect your mental health after work-related stress and illness, get help from a mental health professional. To get workers’ comp benefits while you get the treatment you need, talk to a workers’ comp lawyer. Find a local workers’ compensation lawyer to help you navigate the claims process.