Does workers compensation cover mental health claims?

Recent data from the Centers for Disease Control and Prevention (CDC) show that mental health problems such as depression cause about 200 million lost working days per year, which cost employers between $17 billion and $44 billion. Mental illness is also a leading cause of “disability, absenteeism, poor performance, and loss of performance” among working-age adults.

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These numbers show the importance of mental health problems that need to be taken seriously, according to the Nolo website. However, not all psychological factors are involved in employee compensation.

“The law gives you the right to ask employees for mental health information in certain cases,” the website said. “But there are a lot of hurdles to overcome in proving what you want.”

Who is eligible for compensation?

Workers’ compensation is a type of insurance that covers workers for injuries and illnesses that occur while on the job. It is regulated by each state, which sets different rules for when an employer must receive benefits.

To qualify for workers’ compensation, an individual must be an employee, not self-employed. They will later be able to access medical care and receive a portion of their wages for work-related injuries or illnesses through the program.

In addition, workers’ compensation works like no-fault insurance, meaning that an injured worker doesn’t have to go the complicated route of proving negligence in order to file a claim. But this also means that they often cannot sue their employer for the injuries they suffer.

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What mental health conditions are covered by employer-sponsored insurance?

Providing treatment is difficult, however, when it comes to work-related illnesses. Under workers’ compensation, mental health claims, including stress and anxiety, are reviewed on a case-by-case basis.

In order to get help, most government workers must prove that their work caused their mental health problems. They will also be asked to find out how their problems started because of their work and not their outside life.

“Injuries and illnesses are often easy to diagnose,” wrote Richard Frankel, managing partner of disability services firm Bross & Frankel, in a guide on the firm’s website. “If a person is exposed to dangerous chemicals at work, it is understandable that they may be entitled to workers’ compensation for the illness. But when a person suffers from an invisible illness, such as depression or anxiety, it can be difficult to get benefits because the connection is not visible.”

Psychological injuries that workers compensation policies can help cover include depression, anxiety, post-traumatic stress disorder (PTSD), and depression. The situation must also be severe enough to interfere with the ability of employees to perform their duties.

“Although many people suffer from anxiety or stress at work, it often does not lead to the inability to work,” Frankel said. “However, for some workers, especially work problems or a difficult work environment can lead to a diagnosis of a mental health problem. If the problem interferes with their work to the point of being unable to work, then workers’ compensation benefits can be provided.”

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Frankel mentioned a nurse in the emergency room who regularly sees “accident victims,” ​​which can cause injuries.

“If he can’t work properly because of stress, then he can go to the hospital and get compensation for his wages while he recovers from workers’ compensation,” he said.

Other incidents that may result in traumatic experiences for employees that may be covered by workers’ compensation include surviving a workplace shooting and being assaulted or harassed by an abusive co-worker.

How can employers prove that mental illness is work-related?

Under workers’ compensation, if the employer challenges the claim, it is up to the employee to show that their problems stem from their work. But unlike physical injuries that can be easy to document, proving work-related mental health problems can be very difficult. According to Frankel, a claim for injury or mental illness must have the following elements in order to be reimbursed:

  • The working conditions must be deplorable
  • Credible evidence must support a finding that the employee acted in a way that is problematic
  • Difficulties that work must be “unusual” in other workplaces
  • There must be actual evidence to support the claim of mental disability
  • The court must consider the credibility of the entire case, including any opinions the employee brings to the job

“With mental illness, making the connection between your illness and your work can be difficult,” Frankel said. “Sometimes, there is a traumatic event – like a shooting – that can easily be linked to your mental health. But in other cases, there may not be a direct connection between one event – or a series of events – and your anxiety and stress.

“Many psychological injuries develop over time, as a result of your work or occupational stress,” he added. “This can make it difficult to prove that your injury was caused by work. For example, if your boss is angry, yells at you often, and puts you at unnecessary times, which can cause you stress – but it can be difficult to prove that this stress is not the result of other events in your life, such as. economic problems.”

To deal with these problems, Frankel advised workers to work with mental health professionals who could help them recognize that mental health problems were caused by their jobs. He added that it would be helpful if employees could write down what is going on in their workplace that affects their stress and anxiety.