Psychiatric Injury - Stress Claims - Mental/Mental

Under California Law, for a psychiatric injury to be compensable, the following requirements must be satisfied:

1. The employment must be six months or more.
2. The employee must have a psychiatric condition that is listed in DSM IV
3. The employee must prove that the actual events of employment are the predominant cause of the psychiatric condition (51% or more)
4. A psychiatric condition that is substantially caused (35%--45%) by good faith, non discriminatory personnel action(s) is not compensable as a work-related injury. Examples of good faith personnel actions are criticism of the employee’s work or attendance, change in work assignments, and decision about raises or promotion. The employer has the burden of proof on this issue.
5. A psychiatric injury that is caused by the litigation process is not compensable. Examples of psychiatric injury caused by the litigation process are an employees reaction to the denial of their claim, dealing with an abusive claims adjuster, or having their benefits terminated.
6. A stress claim or mental--mental psychiatric injury claim filed after termination or notice of termination is not compensable unless the employer know of the injury or medical records of treatment for the psychiatric dated prior to the termination exist.

“Stress” is not a psychiatric condition listed in DSM IV. If you have not received psychiatric or psychological counseling as a result of the psychological injury your are alleging, your psychiatric claim likely has little merit.

If you worked at the employer for less than two years, you will also have a more difficult time proving your claim unless it is due to a sudden violent event.

When an employee files a psychiatric claim, they are opening up all aspects of their life for scrutiny by the insurance company. The insurance company will ask about your mental health treatment history, marriage, children, parents, criminal history, litigation history, bankruptcies among many other inquiries. If you don’t want or feel uncomfortable disclosing this information, you should seriously reconsider filing a psychological or stress claim.

If your stress comes from conflict with a supervisor or manager and the conflict concerns your attendance, job performance, job evaluation, job assignment, or other actions that you consider unfair, you claim will most likely be defeated under the good faith personnel action defense. You are better off finding a job at another employer than filing this type of stress claim.

MENTAL – PHYSICAL CLAIMS

Psychiatric claims that are caused by a serious physical injury or physical condition(s) are known as Mental-Physical Claims. Often, a serious physical injury impacts other aspects of an injured workers’ life. Examples of such impacts are sleep disorders, depression and/or anxiety caused by the physical pain, diminished functional ability, and the loss of an injured workers’ profession.

Under the new permanent disability rating system, if you have a serious physical injury that results in your having significant impairment in your activities of daily living, or you are experiencing chronic pain or sleep disturbance, you need to have your psychiatric general assessment of functioning (GAF) considered. This is more important than ever because the new permanent disability rating schedule dramatically short changes those with serious objective physical injuries (contrary to what was promised by Governor Schwarzenegger when SB 899 was signed into law).

It should be noted that in California, psychiatric injury caused by job termination, the emotional reactions to the claims process (i.e. being cut off from benefits, receiving an unfavorable decision, ect.) are not eligible for compensation.

MENTAL – MENTAL CLAIMS

Almost all Mental-Mental (Psychiatric or stress claims that do not also involve a physical injury i.e. Mental-Physical) are denied. Most of these cases are also lost at trial due to the good faith personnel action defense.

A Mental-Mental claim that is caused by being the victim of a crime at work, witnessing a sudden violent event, or being the victim of sexual harassment may be a viable mental—mental claims.

Claims by short term employees (Less than two years) that do not involve the above events above are usually weak claims.

Claims that involve conflicts with supervisors or perceived unfair treatment at work are almost always weak claims.

This office takes very few mental-mental claims.