Workers’ compensation is a form of insurance that provides wage replacement and medical benefits for injuries suffered on the job. The injury must have occurred as a result of regular duties rather than as a result of horseplay or the employee’s negligence. While the majority of claims filed will be related to physical injuries, some mental conditions can be covered by workers’ compensation as well.
However, claims examiners often request a psychological examination to better understand the work-related event and the resulting psychological disorder. Family Psychiatry of North Jersey can assist you in getting your workers’ comp claim approved by providing this examination. But before you take further action with your claim, you need to understand which mental conditions qualify first.
Which Mental Conditions Qualify for Workers’ Comp?
As with all workers’ compensation claims, the mental condition must be caused as a result of the employer’s negligence and not an underlying condition the employee already developed. For most successful workers’ compensation claims, the mental condition should be caused as a result of abnormal or inhumane work conditions. The qualifying mental conditions include:
- Post-traumatic Stress Disorder caused by job conditions or expectations
- Mental conditions developed because of physical injuries suffered at work
- Stress that results in permanent damage and harm
- Stress due to being overworked to the point of exhaustion
When it comes to filing workers’ compensation claims for mental conditions, the process can be significantly more difficult. Rather than simply examining the physical injury and investigating the underlying act that caused it, the employee must prove that the mental condition occurred as a result of a work-related event.
The mental condition cannot be attributed to any other source outside the scope of their duties at work. Employers are often hesitant to approve these claims and will do anything in their power to deny mental condition claims, especially if they’re separate from a work-related physical injury.
The burden of proof is on the employee, and while an experienced psychiatrist can help determine the cause of the mental condition, the lack of physical proof makes successfully establishing a claim difficult. If a workplace exposes an employee to excessive levels of stress that fall outside the scope of industry-accepted stress levels, they may be eligible to receive workers’ compensation.
As part of the investigatory process, individuals can expect the employer to thoroughly examine their personal lives to ensure that the condition was not the result of stress outside of work. Relationships, friendships, finances, and family stress will all be taken into consideration when examining the basis of a claim.
While the employer may be ready and willing to provide compensation for treatment and therapy, their insurance company may not be so generous. Insurance companies do not want to provide coverage unless they clinically prove that working conditions caused the condition. Otherwise, anyone suffering from general stress or anxiety would be eligible to receive workers’ compensation. However, should the work environment clearly cause the condition, the insurance agency representing the employer will be obligated to cover the cost of treatment and associated wage loss.
A successful workers’ compensation claim for mental conditions must show that the condition resulted from unreasonable conditions at work. Remember, not all claims are eligible. If the stress was related to constructive criticism in the course of routine duties or due to being passed over for a promotion, the claim would not be recognized. These stress levels are considered normal and do not fall outside the scope of routine practices. However, if the stress is demonstrably caused by unreasonable expectations or being required to work to the point of exhaustion, the claim will likely be successful.
Mental Conditions as a Result of Physical Injury
The easiest way to prove a mental condition caused by negligence at work is when it’s accompanied by a physical injury. If an employee injures themselves at work during the normal course of duties, they’re entitled to workers’ compensation for the injuries they suffered as well as compensation for wages lost due to missed work. These claims are easy to identify and have the most success in recovering wages.
However, individuals who suffer mental injuries due to the severity of their physical ailments may be eligible for continued support and compensation under workers’ compensation regulations. For these individuals, a psychiatrist will perform an evaluation to appropriately diagnose the employee’s mental condition as well as the severity of the depression or anxiety caused as a result of the physical injury.
If the psychiatrist deems the mental condition so severe that it interferes with the employee’s ability to return to work or perform the duties they’re assigned, the employee may be entitled to long-term benefits. Workers’ compensation can cover lost wages as well as psychiatric treatment or therapy associated with the employee’s recovery.
If the condition is extreme, it is possible that workers’ compensation will help cover a long-term disability claim so the employee can recover fully rather than rushing back into the same stressful situation that sparked the problem in the first place. For these individuals, ongoing treatment with an experienced psychiatrist will help reduce the overall recovery time and may help them return to work more quickly. For those suffering from PTSD, depression, or other related condition, the treatment may continue for years before the employee can adequately cope with the same triggers.
What Happens if the Claim is Approved?
If a workers’ compensation claim for a mental condition is approved, treatments for the condition (including medication and therapy) are covered at the employer’s expense. Continuing therapy and working with an experienced psychiatrist will give the employee the tools they need to cope with the demands of the workplace if they return. Furthermore, they’ll be better equipped for future stressful situations and able to handle increased demands at other centers of employment.
Not only will the employee be compensated for lost wages and given financial assistance to cover the cost of treatment, but the work conditions at their job may change. Once the employer is aware of the hazards, they’ll be able to make changes to ensure that the injury does not happen again. The government bans employers from retaliating against an employee for filing a workers’ compensation claim, but they’re free and encouraged to make improvements brought to light by the claim.
If the Claim is Denied
It is important to note that even if a workers’ compensation claim is denied, the employee’s health insurance policy may cover the cost of therapy. While this may not do anything to alleviate the financial burden of lost wages or help find a less stressful employment option, it still has benefits and may help improve the injured employee’s quality of life.
Regardless of the cause of the mental condition, proper therapy and treatment will give the employee the tools they need to cope with stress and the changes associated with their injury. Working with a qualified therapist may reduce the amount of downtime and get them back to work faster while also reducing the risk of permanent or debilitating mental conditions.
If There’s an Injury, File a Claim
Workers’ compensation claims should be filed as quickly as possible to give the employee the best chance of demonstrating injuries sustained in the work environment. If possible, notify a supervisor of symptoms immediately and begin the documentation process. The workers’ compensation process can be time-consuming, and the sooner an employee initiates a claim, the sooner the claim can be resolved.
If an individual experiences a mental condition due to unreasonable expectations, stress, or anxiety in the workplace, they should file a claim immediately. The faster therapy begins, the sooner they can cope with work-related stress.
Don’t suffer in silence. Schedule a consultation with Dr. Miller and her team at Family Psychiatry of North Jersey today and take back control of your life.