Post-Traumatic Stress Disorder is a Psychiatric Diagnosis that Injured Workers can receive as a result of exposure to workplace stress. In the California Workers’ Compensation System, both Insurance Companies and Employers are well aware of the serious consequences with PTSD injuries. This includes the fact, Workers’ Compensation Laws include several Labor Code Sections that support Injured Workers making PTSD claims.
This article will discuss PTSD, workplace causes of PTSD, risk management approaches to PTSD, and Labor Code Sections that impact to PTSD claims.
What is PTSD?
“Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened, even when they are not in danger.” – National Institute of Mental Health
The Specific and Cumulative Nature of Stressors?
Workplace stressors causing PTSD vary temporally. They can occur in a specific manner such as a robbery. They can occur in a cumulative fashion such an Employee being continually bullied in the workplace.
What Are the Causes of PTSD in the Workplace?
Workplace causes of PTSD can be broken into two categories. There is Workplace Stress and Traumatic Stressful Events.
What Workplace Stress can give rise to PTSD?
Workplaces stressors that can give rise to PTSD include supervisor relations, group morale and cohesion, administrative procedures, workload, shift duties, resources and internal personal conflict Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410, https://doi.org/10.1093/occmed/kqm070
What Traumatic Stressful events can give rise to work-related PTSD?
Traumatic stressful events that can occur in the workplace include mass disasters, serious accidents, threats or death and injury, deaths of colleagues, witnessing deaths, suffering and injury and assault. Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410, https://doi.org/10.1093/occmed/kqm070
Why are Insurance Companies and Employers concerned about PTSD cases?
First, in the event of an obvious stressful event, i.e. a shooting in the workplace, Insurance Companies and Employers realize that the chances of having any legal defense to defeat such a claim is minimum. Therefore, their goal is to minimize the risk.
In other words, the most important goal for Employers and Insurance Companies is to minimize the expenses on the claim. Costs that can be minimized include medical treatment, temporary and permanent indemnity, future medical treatment, and vocational rehabilitation.
How is the Risk Managed in PTSD Cases?
It has been suggested that PTSD risk management should include screening, observation, and treatment. Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410, https://doi.org/10.1093/occmed/kqm070
What is Screening?
As part of Risk Management, there will be an attempt to screen Workers who may be at risk for PTSD. It is noted that “Screening for psychological disorders is an effective strategy in workers who are at significant risk because of their levels of trauma exposure. Such a strategy involves identifying individuals at risk and screening them in the immediate aftermath and again approximately 6 months later.” Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410, https://doi.org/10.1093/occmed/kqm070
Note: Screening presents problems. Are the individuals screening trained to do so? Will the Employees react negatively towards this screening? Is it better that such screening be done by a medical provider provided through a workers’ compensation claim by some other means such as an EAP program?
What is Observation?
Risk Management suggest that Managers observe Workers who are at risk for PTSD. They will be looking for things such as increased alcohol use, interpersonal and or family conflict, social withdrawal, depression, somatic distress and performance deterioration. Supra.
Note: Observation can be very problematic for Injured Workers. Having suffered through a psychiatric disturbance is certainly enough for one person. The notion that Management is tantamount to spying on the individual can add additional unnecessary paranoia and psychiatric symptomology to the already existing PTSD symptoms.
What is Treatment?
“The aim of effective treatment is to minimize these disabilities before they emerge.” Supra. Per Labor Code Section 4600, Injured Workers are entitled to treatment subject to a utilization review schedule and Independent Medical Review.
Note: Minimizing disabilities translates to lower costs on cases. Effective treatment reduces the need for temporary disability, permanent disability, need for future care and need for vocational rehabilitation services. In the Workers’ Compensation System, however, Insurance Companies are slow to act and often deny both treatment and claim.
Why Are Post-Trauma Factors Important in Managing Risk?
As much as what happened to cause the PTSD, events that happen post injury can shape the course an Injured Worker’s claim.
“In the aftermath of the event, a range of factors can modify the recovery or escalate distress such as social support and stress that emerge in the aftermath of the event such as continued exposure to the distress of the victims or critical legal investigations of the circumstances of the event where blame is involved.” Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410, https://doi.org/10.1093/occmed/kqm070
In sum, what happens in the workplace or elsewhere after the PTSD event can have a profound impact on the claim. Therefore, Risk Management principles dictate that Management should continue to view the workplace as an ongoing site of injury. Post Injury events can push individuals who were functioning over the edge and create profound disability.
What Labor Code Sections specifically address PTSD issues?
There are two Labor Code Sections that I view as specifically related to PTSD.
The first is the PTSD Presumption which applies to certain law enforcement and safety offices. This is Labor Code Section 3212.15. For more information concerning this Presumption, click here.
The second is the Labor Code Section which lowers the causative burden for stress claims which involve violent acts. Labor Code Section 3208.3(b)(2) which provides that “ in the case of employees whose injuries resulted from being a victim of a violent act or from direct exposure to a significant violent act, the employee shall be required to demonstrate by a preponderance of the evidence that actual events of employment were a substantial cause of the injury”.[emphasis added]
Note: This was included due to the fact that those events described have a significant possibility of resulting in PTSD. This section lowers the burden of causation from predominant cause (greater than 50 percent) to 35 to 40 percent for the Injured Worker.
What If I Need Legal Advice?
If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years.