Workers’ compensation is a form of insurance that provides wage replacement and medical benefits for injuries suffered on the job. The injury must have occurred as a result of regular duties rather than as a result of horseplay or the employee’s negligence. While the majority of claims filed will be related to physical injuries, some mental conditions can be covered by workers’ compensation as well.
However, claims examiners often request a psychological examination to better understand the work-related event and the resulting psychological disorder. Family Psychiatry and Therapy can assist you in getting your workers’ comp claim approved by providing this examination. But before you take further action with your claim, you need to understand which mental conditions qualify first.
Which Mental Conditions Qualify for Workers’ Comp?
As with all workers’ compensation claims, the mental condition must be caused as a result of the employer’s negligence and not an underlying condition the employee already developed. For most successful workers’ compensation claims, the mental condition should be caused as a result of abnormal or inhumane work conditions. The qualifying mental conditions include:
- Post-traumatic Stress Disorder caused by job conditions or expectations
- Mental conditions developed because of physical injuries suffered at work
- Stress that results in permanent damage and harm
- Stress due to being overworked to the point of exhaustion
When it comes to filing workers’ compensation claims for mental conditions, the process can be significantly more difficult. Rather than simply examining the physical injury and investigating the underlying act that caused it, the employee must prove that the mental condition occurred as a result of a work-related event.
The mental condition cannot be attributed to any other source outside the scope of their duties at work. Employers are often hesitant to approve these claims and will do anything in their power to deny mental condition claims, especially if they’re separate from a work-related physical injury.
Work-Related Stress
The burden of proof is on the employee, and while an experienced psychiatrist can help determine the cause of the mental condition, the lack of physical proof makes successfully establishing a claim difficult. If a workplace exposes an employee to excessive levels of stress that fall outside the scope of industry-accepted stress levels, they may be eligible to receive workers’ compensation.
As part of the investigatory process, individuals can expect the employer to thoroughly examine their personal lives to ensure that the condition was not the result of stress outside of work. Relationships, friendships, finances, and family stress will all be taken into consideration when examining the basis of a claim.
While the employer may be ready and willing to provide compensation for treatment and therapy, their insurance company may not be so generous. Insurance companies do not want to provide coverage unless they clinically prove that working conditions caused the condition. Otherwise, anyone suffering from general stress or anxiety would be eligible to receive workers’ compensation. However, should the work environment clearly cause the condition, the insurance agency representing the employer will be obligated to cover the cost of treatment and associated wage loss.
A successful workers’ compensation claim for mental conditions must show that the condition resulted from unreasonable conditions at work. Remember, not all claims are eligible. If the stress was related to constructive criticism in the course of routine duties or due to being passed over for a promotion, the claim would not be recognized. These stress levels are considered normal and do not fall outside the scope of routine practices. However, if the stress is demonstrably caused by unreasonable expectations or being required to work to the point of exhaustion, the claim will likely be successful.
Mental Conditions as a Result of Physical Injury
The easiest way to prove a mental condition caused by negligence at work is when it’s accompanied by a physical injury. If an employee injures themselves at work during the normal course of duties, they’re entitled to workers’ compensation for the injuries they suffered as well as compensation for wages lost due to missed work. These claims are easy to identify and have the most success in recovering wages.
However, individuals who suffer mental injuries due to the severity of their physical ailments may be eligible for continued support and compensation under workers’ compensation regulations. For these individuals, a psychiatrist will perform an evaluation to appropriately diagnose the employee’s mental condition as well as the severity of the depression or anxiety caused as a result of the physical injury.
If the psychiatrist deems the mental condition so severe that it interferes with the employee’s ability to return to work or perform the duties they’re assigned, the employee may be entitled to long-term benefits. Workers’ compensation can cover lost wages as well as psychiatric treatment or therapy associated with the employee’s recovery.
Long-Term Treatment
If the condition is extreme, it is possible that workers’ compensation will help cover a long-term disability claim so the employee can recover fully rather than rushing back into the same stressful situation that sparked the problem in the first place. For these individuals, ongoing treatment with an experienced psychiatrist will help reduce the overall recovery time and may help them return to work more quickly. For those suffering from PTSD, depression, or other related condition, the treatment may continue for years before the employee can adequately cope with the same triggers.
What Happens if the Claim is Approved?
If a workers’ compensation claim for a mental condition is approved, treatments for the condition (including medication and therapy) are covered at the employer’s expense. Continuing therapy and working with an experienced psychiatrist will give the employee the tools they need to cope with the demands of the workplace if they return. Furthermore, they’ll be better equipped for future stressful situations and able to handle increased demands at other centers of employment.
Not only will the employee be compensated for lost wages and given financial assistance to cover the cost of treatment, but the work conditions at their job may change. Once the employer is aware of the hazards, they’ll be able to make changes to ensure that the injury does not happen again. The government bans employers from retaliating against an employee for filing a workers’ compensation claim, but they’re free and encouraged to make improvements brought to light by the claim.
If the Claim is Denied
It is important to note that even if a workers’ compensation claim is denied, the employee’s health insurance policy may cover the cost of therapy. While this may not do anything to alleviate the financial burden of lost wages or help find a less stressful employment option, it still has benefits and may help improve the injured employee’s quality of life.
Regardless of the cause of the mental condition, proper therapy and treatment will give the employee the tools they need to cope with stress and the changes associated with their injury. Working with a qualified therapist may reduce the amount of downtime and get them back to work faster while also reducing the risk of permanent or debilitating mental conditions.
If There’s an Injury, File a Claim
Workers’ compensation claims should be filed as quickly as possible to give the employee the best chance of demonstrating injuries sustained in the work environment. If possible, notify a supervisor of symptoms immediately and begin the documentation process. The workers’ compensation process can be time-consuming, and the sooner an employee initiates a claim, the sooner the claim can be resolved.
If an individual experiences a mental condition due to unreasonable expectations, stress, or anxiety in the workplace, they should file a claim immediately. The faster therapy begins, the sooner they can cope with work-related stress.
Don’t suffer in silence. Schedule a consultation with Dr. Miller and her team at Family Psychiatry and Therapy today and take back control of your life.
Frequently Asked Questions
Can I file a workers’ compensation claim for stress-related mental health issues?
Yes, in many states, workers’ compensation covers mental health issues like stress, anxiety, or depression if they are work-related. You must prove that your job environment or specific work-related incidents directly caused your mental health condition. This is often more challenging than physical injury claims, as you may need to provide evidence from medical professionals or documentation of work conditions. Some states have stricter requirements or different thresholds for mental health claims. It’s important to consult with a workers’ compensation attorney to understand your state’s specific laws. Filing promptly and with detailed evidence can improve the chances of a successful claim.
Is online therapy an option for workers’ compensation mental health claims?
Yes, online therapy is often a valid option for mental health treatment under workers’ compensation, especially as telehealth becomes more widely accepted. Many insurance providers now cover online therapy sessions, allowing workers to receive mental health care remotely. This can be particularly beneficial for those with high levels of stress or anxiety about attending in-person sessions. It also provides flexibility and convenience, helping individuals access care more easily. However, it’s essential to confirm with your employer or workers’ compensation provider that online therapy is covered. If approved, online therapy can be an effective part of your mental health treatment plan.
What should I do if my workers’ compensation claim for mental health is denied?
If your workers’ compensation claim for mental health issues is denied, the first step is to review the denial letter carefully to understand the reason. Often, claims are denied due to insufficient evidence, paperwork errors, or failure to meet state requirements. You can appeal the decision, and it’s highly recommended to consult a workers’ compensation attorney to guide you through the appeals process. Gathering additional evidence, such as more detailed medical records or expert testimony, may strengthen your case. Filing an appeal promptly is crucial, as there are deadlines for doing so. Additionally, continue seeking treatment for your mental health condition, even while the claim is under appeal.
Does Horizon Blue Cross Blue Shield cover mental health services for workers’ compensation cases?
Yes, Horizon Blue Cross Blue Shield covers many mental health services, including therapy for work-related conditions under workers’ compensation. We proudly accept Horizon BCBS insurance, making it easier for you to access affordable, high-quality care. Contact us to learn how we can assist with your workers’ compensation-related mental health needs.
How can I begin treatment for a mental health condition related to workers’ compensation?
To begin treatment for a work-related mental health condition, you should first seek an evaluation from a licensed mental health professional, such as a psychologist or psychiatrist. Make sure to notify your employer and workers’ compensation provider about your condition and file a claim if you haven’t already. Depending on the outcome, your workers’ compensation provider may offer a list of approved healthcare providers or therapists. Even if your claim is pending, it’s important to start treatment right away to manage symptoms. If online therapy is an option, it may provide more flexibility for treatment. Lastly, follow your healthcare provider’s treatment plan, which may include therapy, medication, or lifestyle changes, to ensure progress. Reach out to us to schedule an appointment in the Paramus & Edison, New Jersey areas.
Additional Information in Paramus & Edison, New Jersey
New Jersey Department of Labor – Workers’ Compensation: Detailed information about workers’ rights and benefits if they are injured or become ill due to work-related incidents. It outlines how to file a workers’ compensation claim, the benefits available for medical treatment, and wage replacement for those unable to work. The site explains the process for disputes or appeals if claims are denied, ensuring workers understand their legal rights. Additionally, it includes contact information for resources and services that help guide workers through the claims process. For workers dealing with mental health conditions caused by workplace stress or trauma, this site helps by offering a clear pathway to file a claim for mental health-related workers’ compensation, ensuring they receive the care and support they need.
National Institute of Mental Health – PTSD: Comprehensive information about PTSD, including its symptoms, causes, and treatment options. It explains how PTSD can develop after experiencing or witnessing a traumatic event and outlines different therapeutic approaches like Cognitive Behavioral Therapy (CBT) and medications. The site also covers the importance of early diagnosis and treatment to manage symptoms and improve long-term outcomes. It provides links to additional resources and support for those affected by PTSD. For workers who have experienced trauma in the workplace or elsewhere, this site offers valuable information on recognizing PTSD symptoms and seeking appropriate treatment, promoting better mental health and recovery.
New Jersey Division of Mental Health and Addiction Services: Detailed information and resources for mental health and addiction services in the state. It offers access to programs that support individuals dealing with mental health challenges, including treatment options, crisis intervention, and recovery support. The site connects users to community-based services and provides information about mental health initiatives aimed at enhancing care. DMHAS also focuses on integrating mental health and addiction services to ensure comprehensive care for those in need. For workers facing mental health issues, this site can help by offering access to local support services, treatment programs, and resources designed to assist in recovery and maintain mental well-being.
Substance Abuse and Mental Health Services Administration – Stress Management: Offers various healthy coping strategies, including breathing exercises, to manage stress effectively. It provides practical guidance on relaxation methods, mindfulness, and breathing techniques that can help reduce stress and promote emotional well-being. The site emphasizes the importance of managing stress to prevent it from escalating into more serious mental health issues like anxiety or depression. It also includes resources and tools for individuals seeking to incorporate these techniques into their daily lives. For workers facing mental health challenges, especially those dealing with stress in a high-pressure environment, these techniques can be invaluable in improving emotional resilience and preventing burnout.
Horizon Blue Cross Blue Shield Workers’ Compensation Services: Explore Horizon BCBS’s dedicated services for workers’ compensation, including specialized care management and support for work-related injuries and conditions. Learn how their network ensures seamless and effective healthcare solutions for employees recovering from workplace incidents.