A large number of workers in the state of California are well aware of the workers’ compensation provided by the state covering most work-related physical illnesses and injuries. This coverage applies to sudden accidents and injuries, not to mention gradual illnesses that develop over time. However, most workers do not realize that the existing statutes provide coverage for psychiatric work injuries as well. It can be quite hard to prove these claims given the nature of psychiatric injuries and the effects they can have on a victim’s life is different than a physical injury or sickness. Suffering a mental illness could pose a challenge when it comes to filing the necessary paperwork and meeting the set deadlines. It is also not uncommon for employers to challenge psychiatric work injury claims, insisting on seeing the medical documentation and numerous paperwork before a claim can be authorized. In the unfortunate event that you are a victim of a work-related psychiatric injury, you will need all the information you can find regarding this complicated field, which might help speed up the claims process.
What is Considered a Psychiatric Work Injury in California?
If a worker suffers a mental injury stemming from their working environment, the state of California regards it as a psychiatric work injury. In short, any work-related mental disorder which causes disability or the need for medical treatment is a psychiatric work injury. The thing with psychiatric work injuries is that most of them take time to develop or even show signs. Constant workplace abuse, harassment, and being overworked include some of the reasons that could lead to psychiatric injuries in a worker. Such incidents could stress a worker out to the extent of diminished psychological health. When a worker loses their confidence and energy, they might be incapable of performing their tasks at work or miss out on work altogether.
How Do I Prove My Psychiatric Injury Is Work-Related?
Under Labor Code 3208.3 of the California labor laws, there are several requirements that you should meet if your psychiatric work injury is to be compensated accordingly. Apart from seeking out mental health services, the law also requires that:
- You need to have been working under your employer for a minimum period of six (6) months,
- You need to have been diagnosed with a disease listed in the latest record of the Diagnostic Statistical Manual of Mental Disorders,
- You are obligated to prove beyond doubt that the disorder was primarily brought about by the events of your employment. The law requires you to show that your work environment or work activities were more than 51% of what caused your mental illness,
- It would be best if you showed that your condition was not a result of good faith actions. This means that any judgment or action taken by the employer such as; commentary on your work, changing your tasks or the choice on possible promotions or raises at work will not be considered as solid grounds for causing your illness. The employer, in this case, needs to show that their good faith actions led to your mental condition, in which case they will have beaten your compensation claim,
- Your condition did not result from a related legal proceeding. The California workers’ compensation does not provide coverage if your illness stemmed from an associated litigation process,
- You filed a compensation claim before the termination of your employment. Any form of the claim that you file after your employment has ended is not valid, not unless your employer had prior knowledge of your illness or medical treatment for the illness,
- Stress alone does not qualify as a psychiatric work injury; hence, no workers’ compensation is awarded. This information is according to The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
In addition to the requirements discussed above, you need to demonstrate your efforts at soothing your injuries. The best way to do this is by providing proof of your consistent treatment concerning your psychiatric injuries. It is recommended that your doctor issue you with the most recent record of your visits after every session, which you can present to your employer or their insurance provider upon request.
Ensure that you observe all treatment options that your doctor recommends; this includes medication, Neurotherapy, physical exercise, and support groups. This is because such treatment options for California employees necessitate funds from The Workers’ Compensation, which further emphasizes the aspect of obtaining the newest appointment list from your doctor.
Additionally, you should request for pharmaceutical records from your doctor in case they prescribe any medication since the insurance company might demand proof of you taking the recommended dosage.
What Types of Psychiatric Claims are Covered by Workers’ Compensation in California?
As per the California law, there generally exist two kinds of psychiatric claims. The type of claim that you file depends on the nature and extent of the injury which you sustained. They include:
a) Mental-Physical Claims
These kinds of claims refer to the psychiatric injuries that come about as the downright result of a bodily injury; inducing pain, reduced functional ability, or job loss as a result of a work-related injury. Most mental-physical claims include conditions such as troubled sleep, anxiety, panic attacks, depression, and other physical elements.
b) Mental-Mental Claims
These kinds of claims do not entail any physical injury. A violent or traumatic incident commonly instigates them at work; for instance, witnessing or undergoing a disturbing event such as violence, physical assault, or sexual abuse.
Mental-physical claims have over the years found greater success when compared to mental-mental claims. This is since it is by far easier to prove that you sustained a job-related mental injury once you link it to physical damage. For instance, showing that you suffer solely from depression, which was directly caused by a job-related incident might be quite a hard task. If you, however, were to link the depression to a prior back or neck injury, it becomes easier to show that your mental injury was the result of a job-related incident.
At this point, it should be pretty apparent on the most appropriate claim for you to file. There are certain situations that, however, might still be unclear on the best option. By filing an improper claim, you risk having it turned down, hindering your chances of receiving the funds that are necessary for your treatment. In the event that you find the options confusing and need clarification, consider seeking advice from your doctor. Their opinion regarding the extent and nature of your injury will help you make a sound decision. It is also advisable that you consult with a lawyer, who will break down the process further for you.
Compensation Options for Psychiatric Work Injuries
In the event that you suffer a psychiatric work injury, the state of California provides you with two (2) options in which you might seek compensation.
The first option involves filing a workers’ compensation claim. For your claim to even be considered, you need to meet all the requirements discussed above. Your lawyer, as well as your doctor, must also have confidence in the success of your claim; otherwise, this might not be an ideal action for you. The good thing about this option is the fact that the process of filing a workers’ compensation claims is usually not costly. A good lawyer will charge you reasonably for their guidance and assistance.
Option number two involves you taking legal action against your employer. Filing a lawsuit should be considered as the last resort and might be your only approach after failing to meet the requirements for the workers’ compensation claim. You might also consider this option if you want to sue your employer not only for medical compensation but also for severe damages.
It should be noted that pursuing both options, either concurrently or successively, is prohibited in the state of California. In the event that you decide to file a workers’ compensation claim, you are forbidden by the law from suing your employer. Equally, the law bars you from filing a workers’ compensation claim in case you choose to sue your employer. The best approach to take will depend on the distinctive elements of your case. It is best if you figured your odds of succeeding with either of the two options, whether you meet the set requirements or not, the amount of payment you deem rational, as well as the time and money you are willing to invest in the claim.
What Is Covered by Workers’ Compensation in California?
In the state of California, the workers’ compensation provides insurance for several expenses. They include;
- Health care, rehabilitation, and medication,
- Replacement of lost wages and;
- Any costs incurred in your retraining if a career switch is required.
The earnings that you receive from the replacement of lost wages are not taxable and are paid out almost immediately. These earnings are customarily worked out at two-thirds of your salary. The monetary benefits are subsequent; hence, no wages are lost for the days that you initially missed work in the event that you are not able to file your claim right away.
The California workers’ compensation neither provides coverage for punitive damages, nor any financial benefits for pain and suffering on your part, or that of your family. This is the main reason why you need to carefully take into consideration the best option for your compensation before pursuing either of the two.
Additionally, the benefits that are provided for psychiatric work injuries in California will generally be more limited than what you would receive for physical work injuries. Permanent disability benefits for a psychiatric injury will be challenging to obtain since it is presumed that you will recover completely and find a new job once you leave the frustrating work setting.
What Documents Are Required in The Pursuit of a Psychiatric Compensation Claim?
It is worth noting that a psychiatric work injury claim will undergo heavy scrutiny by employers and their insurance companies when compared to a physical injury claim. As a result, you need to collect as many relevant papers as possible. Starting from where your psychiatric injury originated, ensure that you gather every single material that indicates your place of work as the leading cause. This might include statements by witnesses who might have known the events that lead to your injury.
Any documents that contain your medical history are very significant as well; this includes any record of your physical and mental health. With this information in mind, it is only right to notify your doctor in advance and keep them in the loop. Doing so will ensure they have ample time to gather and prepare the necessary medical information. Some insurance companies might also request for more personal data, i.e., your financial and material welfare. This denotes the arrangement of your family, your business documents, your criminal record, as well as any lawsuits that you might have been a part of previously.
Having this kind of information readily available will save you headaches, but at the same time, you are not obligated to provide certain documents unless requested. There are other documents that you may voluntarily want to share so that you can help your case. If you are not conversant with workers’ compensation claims, it can be quite challenging to differentiate between these documents. Hiring a competent lawyer to assist out will be the best option in this case. They will make sure that you have filed all the essential, suitable, and useful documents at the best time possible.
In this day and age, most people will feel uncomfortable and insecure when handing over information regarding their financial records and medical history. Sadly enough, the current laws that have been put in place permit insurance companies to make such kinds of requests. Failing to present the requested information will most likely result in the denial of your claim. Your lawyer could, however, work hand in hand with the insurance company to ensure they only receive the information they require to either validate or invalidate your claim.
The majority of psychiatric work injuries are not easily detected since they do not present any visible signs and symptoms. Due to this reason, proving the existence of mental illness becomes a difficult task. This is also the reason as to why most claims of this nature are primarily disproved. Furthermore, it is not uncommon for such claims to be rejected if they are not filed by the set deadline, or accurately completed. Most workers are usually unsure of the compensation option that will work best in their cases: suing their employers or filing a compensation claim.
How Can My Employer Defend a Psychiatric Compensation Claim?
In order to avoid the costs that would come with compensating your work-related psychiatric injuries, your employer might defend the claim by arguing that your claim is a retaliation towards their good faith actions, otherwise known as good faith personnel actions. These actions are valid business activities, according to the state of California. They include; evaluating, criticizing, relocating, disciplining, and stripping of an employee’s rank.
If your work-related psychiatric injury was mostly caused by a legal, unbiased, good faith personnel action, it is not considered a work injury. In the event that you claim a psychiatric work injury, your employer could have a solid defense by arguing that the actions you claim to have caused your damage, to be just good faith personnel actions.
California Workers’ Compensation Ratings for Psychiatric Claims
In the state of California, the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is used to diagnose a psychiatric work injury.
The Global Assessment of Function scale, on the other hand, is the rating used to rate different levels of psychiatric impairment. The results provided by the GAF are then changed to a percentage, which is then adjusted either down or up employing the Permanent Disability Rating Scale (PDRS) to give the permanent disability value. Ratings of 70 and below indicate permanent disability in a victim.
The Global Assessment of Function scale provides a score that runs from levels 1 through 100 with a range of 10 for each level. The GAF scale considers a victim’s social, professional, and mental functioning in the calculations. The different levels of psychiatric injuries include:
- a) 91-100 – Flawless performance in a variety of actions
- b) 81-90 – negligible signs such as slight anxiety but overall functioning well
- c) 71-80 –slight or brief symptoms in the face of aggravation
- d) 61-70 – minor symptoms such as depressed temperament or mild sleeplessness and some difficulty in performance
- e) 51-60 – mild symptoms like disputes with coworkers and few associates
- f) 41-50 – acute signs including suicidal ideas, unlawful conduct, incapacity to retain a job
- g) 31-40 – trouble functioning at work, personal relationships, school and general lack of common sense
- h) 21-30 – failure to perform, confusion, daydreaming
- i) 11-20 – a risk to both themselves or others
- j) 1-10 – a constant threat to themselves or others, oblivious of personal cleanliness.
Factors to Consider Before Filing a California Psychiatric Claim
It is of utmost importance that you understand how the claims process for a psychiatric injury in California works, and if you are likely to succeed. There are several factors which you should know before proceeding to file a Psychiatric compensation claim. They include:
- A work-related psychiatric injury differs from a physical work-related injury.
- As an injured worker in California, you are required to prove that more than 50% of your psychiatric injury is as a result of an event at work, or your working conditions. This is not required when proving a physical injury.
- In the event that you were employed for a period of less than two (2) years, you will have a hard time proving your psychiatric claim. Such a claim is only considered if an unexpected violent event caused your illness.
- Claims of your stress stemming from conflicts between your employer and yourself regarding any aspect of your job are likely to be defeated. Your employer will defend their actions as being good faith personnel actions.
- Since your mental condition is the main issue; the insurance provider is permitted to question you on personal matters which you might consider private or embarrassing. These questions might involve:
- a) Your sex life,
- b) Any form of abuse you might have suffered in the past,
- c) Past and current medical conditions,
- d) Relationship matters with your family and friends.
In the case of physical injuries such as a simple back injury, said questions are not obligatory but are permitted for mental injuries. It is, therefore, essential to be aware of such kinds of questions being asked. You should also consider if filing a psychiatric compensation claim is the best decision for you.
Why Was My Psychiatric Compensation Claim Denied?
Apart from failing to meet the set requirements when filing for a work-related mental injury in California, there are other factors that could lead to your claim being denied. They include:
- Your employer shows that good-faith, unbiased personnel actions were greatly responsible for your mental injury,
- You filed a claim after being notified that your employment was coming to an end. Your claim will not be considered unless your injuries resulted from abrupt and unexpected events at your workplace, or you meet the requirements for one of the other limited exceptional cases.
Find a Workers’ Compensation Attorney Specializing in Psychiatric Work Injuries Near Me
In the event that you suffer a psychiatric injury due to an incident or the conditions at your place of work, you need to get in touch with a proficient workers’ compensation lawyer. Consulting with a great lawyer from an early stage will enable you to decide on the most appropriate compensation option for a successful outcome based on the unique factors of your case. If you are situated or work in the Orange County area, consider contacting an Orange County work comp attorney regarding any legal aspect of your psychiatric injury. We know how stressful a claims process can become, especially for someone suffering a psychiatric injury, and are here to help. For further questions and clarifications, schedule a meeting with one of our top lawyers by dialing 562-485-9694 today.