What to Expect From a Psychiatric Workers’ Comp Claim in CA

When we think of workers’ comp injuries, we generally think of physical injuries like broken bones, tissue damage, burns, and lacerations. But workers’ compensation also includes psychiatric injury, which is a mental disorder determined to be at least 50% caused by the workplace. 

How to claim a psychiatric injury.

To obtain compensation for a psychiatric injury, an employee must:

1. Show employment for six months or longer
2. Prove that work activities or the work environment were greater than 50% of the cause of psychiatric injury
3. Prove the injury was not a consequence of physical injury

If the psychiatric injury was caused by a violent act, then the employee must show that 35-40% was caused by work. In addition, the six-month requirement doesn’t apply to injuries caused by a sudden and extraordinary event.

Can physical and psychological injuries be combined in a claim?

A psychological injury cannot be caused by a physical work injury. An injured employee can only add a psychological claim to the original injury if it was due to a violent crime or a catastrophic injury such as paralysis, severe burn, amputation, or severe head injury.

What is the difference between an injury and a permanent disability?

If the worker has not sustained a psychiatric work injury, then they will not receive any medical treatment, temporary disability, or permanent disability. If a physician does identify a psychiatric injury in a worker, then the extent of disability and evaluation of non-work-related factors will be determined on a separate basis.

How a psychiatric claim is rated in CA workers’ comp.

In California, a psychiatric work injury is rated using the Global Assessment of Function (GAF) scale, which is then converted to a percentage and adjusted up or down using the Permanent Disability Rating Scale (PDRS). A GAF rating below 70 is considered a permanent disability.

What to expect during a psychiatric injury claims process.

To determine a worker’s eligibility for compensation, the insurance company will ask questions about the workers’ relationship with friends and family, medical conditions, sex life, past abuse, and trauma. An injured worker should decide if filing a psychiatric claim is worth answering questions on such personal matters.