In workers’ compensation cases, a psychiatric injury is a mental disorder that is determined to be at least 50% caused by work. It requires medical treatment or causes disability. Generally, an employee with a psychiatric injury must:
- have worked for the employer for six months or longer,
- show that work activities/work environment were greater than 50% of the cause of the psychiatric injury, and
- not be a consequence of a physical injury.
If the injury is from a violent act, the injured worker only has to show 35-40% was caused by work.
Similarly, the six-month requirement does not apply if the cause of the injury was a sudden and extraordinary event.
The six months employment with the same employer does not have to be continuous.
Claim Process
An employee cannot file a psychiatric claim from a physical injury.
The employer can defend a psychiatric claim by arguing that it was the result of a good faith personnel action. A valid personnel action includes performance reviews or reprimands and cannot be used to file a psychiatric claim.
A psychiatric injury is evaluated using the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Third Edition – Revised.
In California workers’ compensation, the issue of whether there is a psychiatric injury is evaluated differently than the amount of psychiatric permanent disability and apportionment to other causes.
A psychiatric injury is rated on a scale from 1 to 100 using the Global Assessment of Function (GAF) scale in the Permanent Disability Rating Schedule and converted to a permanent disability percentage.
In this article, our California personal injury attorneys will explain:
- 1. What is a psychiatric injury?
- 2. What are the requirements to claim a psychiatric injury?
- 3. Can an injured worker combine physical and psychological injuries into one claim?
- 4. How can an employer defend a psychiatric claim?
- 5. The cause of an injury v. the permanent disability
- 6. How is a psychiatric claim rated in California workers’ compensation?
- 7. Issue to be aware of when filing a psychiatric injury
A psychiatric injury in California workers’ compensation is a mental disorder that causes disability or need for medical treatment.
1. What is a psychiatric injury?
A psychiatric injury in California workers’ compensation is a mental disorder that causes disability or need for medical treatment.1
Example: Wendy is a nurse and deals with patients with cognitive difficulties. The patients are uncooperative and sometimes combative. Her supervisor is always pushing her to work more hours and telling Wendy she is lazy. Wendy is stressed about her work situation.
She cannot sleep and has lost her appetite. She goes to the emergency room because she thinks she is having a heart attack. The ER doctor determines instead that she is having a panic attack.
The ER doctor suggests she get treatment for her anxiety.
Wendy can file a claim for a psychiatric work injury, as she believes her stress and anxiety comes from her work situation.
2. What are the requirements to claim a psychiatric injury?
To be considered a work injury, actual events of employment must be the “predominant cause” of the injury.2 Work must be greater than 50% of all causes of the injury.3
Example: Aaron is a security guard and claims a psychiatric injury from work due to a bad work environment. His supervisor makes fun of him and tells him that he’s terrible at his job.
Aaron is depressed and has difficulty sleeping. He has stopped most of his social activities.
A doctor examines Aaron and learns that both of his parents recently passed away. The doctor decides the main cause of Aaron’s psychiatric symptoms comes predominantly from his personal life and assigns this a value of 60%, with the remaining 40% from work.
Since greater than 50% of Aaron’s psychiatric symptoms come from personal issues, his claim for a work injury will fail.
2.1. A violent act
If the injury is the result of a violent act, the employee only has to show that 35-40% of the psychiatric cause was from work.4
Example: Jessica works in a jewelry store. The store is robbed at gunpoint. Jessica files a claim for a psychiatric injury.
Jessica has a child who is recently diagnosed with a serious medical condition. She is extremely worried and anxious about this.
Her doctor finds that 60% of her psychiatric injury is from her child’s medical condition and 40% from the robbery. She has a valid claim.
Normally Jessica must show that more than 50% of her injury is from work. But because the incident at work was a violent act, she only must show that 35-40% was from the robbery to claim a work injury.
2.2. Six-month employment
To file a psychiatric injury, an employee must be employed for at least six months with the employer. But the six months does not have to be continuous.5
Example: Edwin has worked at a landscaping company for five and a half months. His supervisor constantly makes fun of him, and his coworkers are not friendly to him.
He can’t sleep and has constant headaches. He is unable to continue working due.
Edwin wants to file a psychiatric injury, but it will fail because he has not yet worked six months for the employer.
If Edwin were to come back to work after a week off and work two more weeks, he would meet the six-month requirement. He could then file a psychiatric claim.
The six-month rule does not apply if the injury is the result of a “sudden and extraordinary employment condition.”6
An incident that occurs at work that is uncommon, unexpected, or unusual is a sudden and extraordinary employment condition.7
Example: Dara works in an office. One day she is cornered by her manager in his office and harassed. After this, she has difficulty going to work and cannot interact with the manager without significant anxiety.
She has only worked for the company for three weeks. However, the manager’s actions are an exception to the six-month rule. It is an uncommon and unexpected event.
Dara can file a psychiatric claim under the sudden and extraordinary employment exception.
A psychological injury must be caused by work conditions. It cannot be the consequence of a physical work injury.
3. Can an injured worker combine physical and psychological injuries into one claim?
A psychological injury must be caused by work conditions. It cannot be the consequence of a physical work injury.8
Example: Karen has a severe back injury at work. She is in constant pain. Due to the pain, Karen gets very depressed and has difficulty doing daily tasks. Karen wants to add to a psychological injury to her claim.
Karen cannot add a psychological claim because her psychological complaints come from a physical injury, not directly from work.
However, there are exceptions to this rule. The additional psychological claim is allowed if the original injury was due to:
- a violent crime
- a catastrophic injury such as amputation, paralysis, severe burn, or severe head injury9
Example: Jeff’s arm is amputated in a machine accident at work. Jeff files a claim for a work injury.
After the injury, Jeff becomes very depressed about the loss of his arm. He adds a psychiatric claim to his work injury.
Jeff can do this because his original physical injury was a catastrophic injury.
4. How can an employer defend a psychiatric claim?
An employer can defend a psychiatric claim by claiming that the employee is reacting to a good faith personnel action of the employer. A good faith personnel action is a valid business activity such as
- reviewing,
- criticizing,
- demoting,
- transferring, or
- disciplining an employee.10
A psychiatric injury substantially caused by a lawful, nondiscriminatory, good faith personnel action is not a work injury.11
Once an employee claims a psychiatric injury, an employer can argue that the actions that the employee claim caused the injury are good faith personnel actions.12
Example: Greg is an assistant manager at a retail store. At his recent review, Greg is given bad ratings and told he may be demoted if he does not improve.
Greg is concerned about his job, afraid to make a mistake, and worried that he might be fired. Greg files a psychiatric claim.
The employer will argue that the cause of Greg’s psychiatric problems should be considered good faith personnel actions. They are part of the employer’s valid business activity.
If there is a trial on the issue of whether a psychiatric claim is a good faith personnel action, the following steps will apply:
- Is the claim for a psychiatric injury due to actual events of employment?
- Is work greater than 50% the cause of the psychiatric injury?
- Are any of the actual events of employment good faith personnel actions?
- Are the personnel actions a substantial cause (35-40%) of the injury?13
The events of employment and personnel action are determined by a judge, not a doctor.14 The issue of causation is determined by a doctor.
Example: Terri is an accountant. During tax season she is overwhelmed with work and falls behind and makes mistakes. The employer writes up Terri for poor work performance twice in one month.
Terri becomes anxious and depressed about work. Her doctor prescribes her anti-depressants. Terri files a claim for a psychiatric injury.
The employer claims that their actions are good faith personnel actions and so Terri’s claim should be dismissed.
Terri is seen by a med-legal doctor for an evaluation. The doctor finds that 100% of Terry’s injury is from work. Terry’s psychiatric injury is a combination of overwork and poor performance reviews. The doctor says that 75% is from overwork and 25% is from the poor performance reviews.
At the trial, the judge finds that all the actions that led to Terry’s psychiatric complaints are related to work. The judge also finds that the employer’s action of writing up Terry for poor work performance was a valid personnel action.
Terry has a valid work injury because the good faith personnel actions were only 25% of her injury and not a substantial cause of her psychiatric injury.
5. The cause of an injury v. the permanent disability
Determining if work is a substantial cause of a psychiatric injury is a separate issue from the permanent disability and apportionment determination.
Whether there is a psychiatric work injury is determined before any other issue. If there is no psychiatric work injury, there will not be any medical treatment, temporary disability, or permanent disability.
Once a doctor finds that there is a psychiatric injury, the determination of any permanent disability and possible non-work-related factors is a separate analysis.
Example: Mark has filed a claim for a psychiatric injury. The insurance company has denied the claim.
To resolve the dispute, Mark is seen by a med-legal evaluator.
The doctor first states that 65% of the cause of the psychiatric injury is from stress at work due to too many responsibilities and complaining customers. The remaining 35% is due to difficulties in Mark’s relationship with his children.
Based on this, the doctor finds there is a work injury.
Mark is treated for several months. His condition stabilizes. The doctor writes a report stating that Mark is permanent and stationary. Mark has a GAF score of 63. Because it is less than 70, there is psychiatric disability. The doctor apportions 80% to the work injury and 20% to Mark’s relationship issues.
6. How is a psychiatric claim rated in California workers’ compensation?
A psychiatric work injury is diagnosed using the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Third Edition – Revised.15
Psychiatric impairment is rating using the Global Assessment of Function (GAF) scale.16 The GAF score is converted to a percentage and then adjusted up or down using the Permanent Disability Rating Scale(PDRS).
The GAF scale gives a score from 1-100 in ranges of 10, and it considers psychological, social, and occupational functioning. The levels are:
- 91-100 – superior functioning in a wide range of activities
- 81-90 – minimal symptoms like mild anxiety but good functioning
- 71-80 – temporary or slight symptoms in face of stressors
- 61-70 – mild symptoms like depressed mood or mild insomnia and some difficulty functioning
- 51-60 – moderate symptoms such as conflicts with peers and few friends
- 41-50 – severe symptoms such as suicidal thoughts, minor criminal behavior, inability to keep a job
- 31-40 – difficulty functioning in work, school, family relations, and lack of judgment
- 21-30 – inability to function, delusional, hallucinations
- 11-20 – in danger of hurting self or others
- 1-10 – persistent danger to self or others, lack of personal hygiene17
The GAF score is converted to a permanent disability value using a chart in the PDRS. There is no permanent disability unless the rating is below 70.
Example: Alice has a valid psychiatric claim for stress due to having to do the work of two employees. After treatment and going off work and receiving temporary disability, Alice has returned to work.
She has a med-legal examination with a psychiatric Qualified Medical Evaluator. The doctor finds Alice’s condition has stabilized and she has a GAF score of 71.
Alice does not have any permanent disability because her GAF score is not below 70.
7. Issue to be aware of when filing a psychiatric injury
A psychiatric work injury is different than a physical work injury.
First, the injured worker must prove that greater than 50% of his or her psychiatric injury is caused by work. There is no such requirement for a physical injury.
Second, as the issue is the employee’s mental condition, the insurance company will be able to ask the injured worker many personal questions that may be embarrassing or private.
The questions may include
- relationship issues with friends and family,
- sex life,
- medical conditions,
- past abuse, etc.
These questions are not necessary for a simple back injury but are allowed for psychological injuries.
An injured worker needs to be aware that these questions will be asked and decide if filing a psychiatric claim is worthwhile.
Note that starting in 2020 through 2024, certain firefighters and peace officers may be able to recover workers’ comp for PTSD (post-traumatic stress disorder). California Senate Bill 542 (2019).
Call us for help…
Our attorneys are available to assist with any workers’ compensation matters.
For help with filing a workers compensation claim in California, completing workers comp forms or appealing a denial of benefits, contact us. Our firm helps police officers, firefighters and other workers to get compensation for their job-related injuries in California.
Legal References:
- Cal. Lab. Code § 3208.3(a).
- Cal. Lab. Code § 3208.3(b).
- Dept. of Corrections v. WCAB 1999 Cal. Wrk. Comp. LEXIS 5693.
- Cal. Lab. Code § 3208.3(b).
- Cal. Lab. Code § 3208.3(d).
- Cal. Lab. Code § 3208.3(d).
- State Compensation Ins. Fund v. Workers’ Comp. Appeals Bd., (2012) 204 Cal. App. 4th 766, 772.
- Cal. Lab. Code § 4660.1(c)(1).
- Cal. Lab. Code § 4660.1(c)(2).
- County of Sacramento v. Workers’ Comp. Appeals Bd. (2013), 215 Cal. App. 4th 785, 790.
- Cal. Lab. Code § 3208.3(h).
- Cal. Lab. Code § 3208.3(h).
- Rolda v. Pitney Bowes (2001) 66 Cal. Comp. Cases 241.
- County of Sacramento v. Workers’ Comp. Appeals Bd. (2013), supra at 791.
- Cal. Lab. Code § 3208.3(a).
- Schedule for Rating Permanent Disabilities (2005) State of California.
- Schedule for Rating Permanent Disabilities (2005) State of California p. 1-14, 1-15.