The Complicated World of Workers Comp Psychological Injuries
One subject that has long been the bane of claims adjusters is workers’ comp psychological injuries.
Earlier this week, I included mention of a session at the upcoming WCRI Annual Conference on mental injuries resulting from an on the job injury. Please do not think that I disbelieve or have never accepted a resulting mental injury from a Workers Comp file.
I have accepted and paid benefits on Physical> Mental claims. A brain-injured claimant can easily have mental concerns for many years after a Workers Comp injury. These types of claims baffle many new adjusters.
Two schools of thought exist in many claims departments. One opinion is that no psychological injuries should be accepted on any claim unless a very extreme circumstance exists on the claim.
Some state Workers Comp courts have ruled that psychological injuries should be accepted in some cases including a mental injury that results from no physical injury.
The four types of injuries in Workers Comp are:
Physical > Physical – an employee physically injures themselves which results in a physical injury that must heal over time. This type of injury is the most prevalent in Workers’ Compensation. If a treating physician deems a person to be unable to return to work, and the claim is considered compensable, then the applicable benefits are usually paid on the claim
- Physical >Mental – an injured employee incurs a psychological injury from the aspects of an on the job injury. This type of injury comes from the physical >physical injury in the previous bullet point. Many claim departments remain, staunch defenders, that no mental injury results from a physical injury. Many claim departments bristle when asked to pay for psychological benefits. One can find many cases where a Workers Comp court decision was rendered where mental injury benefits are ordered paid to the claimant. This remains a strong point of contention in some files.
- Mental > Mental – the most complicated type of claims for adjusters to handle consists of an employee having a purely mental claim from the workplace. Some Workers Comp courts have ordered benefit payments on mental > mental claims. Workers Comp claims departments usually litigate these types of files before payment. Many of these types of claims are appealed if the claimant or insurance carrier does not prevail in litigation.
- Mental > Physical – a very rare file where a mental injury results in a physical injury. The one main controversial area with this type of claim is Reflex Sympathetic Dystrophy. The definition of RSD has changed over the last few years to include Complex Regional Pain Syndrome. A claims adjuster may never see this type of injury in their career
Please remember that I am writing this article in laypersons terms from my own experience and the experience of my co-workers over the years. I am giving no medical advice concerning Workers Comp psychological injuries.
©J&L Risk Management Inc Copyright Notice