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IT’S UNDERSTANDABLE that a work-related injury or illness would be covered by workers’ compensation insurance. But what about “stress claims,” which are defined as emotional, mental and psychiatric conditions due to a work-related physical injury or a traumatic event? In California under California Labor Code 3208.3, stress claims may qualify for workers’ compensation benefits if the condition meets specific criteria — that is the key.

Stress claims can be challenging

Stress claims can be difficult to prove since a mental disorder may stem from any number of factors. Proving that a psychiatric or mental disorder stems from work-related stress can be particularly challenging. That’s one reason California labor law requires that at least 51% of the employee’s diagnosed psychological issues are due to the work environment.

Additionally, the employee must have worked for the employer for at least six months and the psychiatric condition:

  • Must be diagnosed by a psychologist or psychiatrist
  • Must be listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders; “stress” is not listed as a psychiatric condition in the DSM-5 1
  • Must not have been caused by the employer’s good-faith non-discriminatory personnel actions (such as a bad review, change in responsibilities, denial of promotion or raise)
  • Must not have been caused by litigation

1. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013)

Two Types of Psychiatric Claims
Understanding the difference

Mental-Physical

Claims refer to psychiatric injuries that result from physical pain, diminished functioning or inability to perform the job due to a work-related injury. These include panic attacks, sleep disorders, depression and anxiety.

Mental-Mental

Claims refer to psychiatric injuries that are not related to a physical injury and may be caused by a traumatic or violent event, including witnessing such an incident. In many cases, simply discussing a “mental-mental” issue is too “stressful” for the employee. That’s why it’s critically important to have an experienced team of psychologists and psychiatrists with specialized expertise to perform necessary evaluations.

Mental-Physical

Claims refer to psychiatric injuries that result from physical pain, diminished functioning or inability to perform the job due to a work-related injury. These include panic attacks, sleep disorders, depression and anxiety.

Mental-Mental

Claims refer to psychiatric injuries that are not related to a physical injury and may be caused by a traumatic or violent event, including witnessing such an incident. In many cases, simply discussing a “mental-mental” issue is too “stressful” for the employee. That’s why it’s critically important to have an experienced team of psychologists and psychiatrists with specialized expertise to perform necessary evaluations.

California’s MPN

A medical provider network (MPN) is a designated group of health care providers used by employers to treat employees injured on the job. In California the MPN must meet certain requirements including:

Providing nearby access to treatment in a timely manner and delivered by an integrated team of physicians and health care facilities that specialize in workers’ compensation.

To formulate the best treatment plan for employees with a stress claim, the right team of behavioral health professionals is needed to properly evaluate, test and document the findings. In California those providers should belong to the employers’ MPN where applicable.

The Extensive MPN of IMCS

IMCS providers belong to many California MPNs and are readily available to provide evaluations to determine compensability and develop an effective treatment plan for employees with a stress claim. Our comprehensive assessment protocol includes:

  • Interview and history
  • Mental status exam
  • Psychological assessment
  • Reporting
  • Work status

Effective treatment = Earlier return-to-work

An IMCS Evaluation Report helps determine the most effective treatment plan to enable the employee’s return to functional wellness and work. The report is intended to document and substantiate:

  • If the injured employee meets the DSM-5 diagnosis criteria for a Stress Claim
  • If the diagnosis is predominantly due to a work-related issue
  • Whether work stressor(s) are in relation to a ‘good faith’ personnel action
  • If pre-existing factors account for the symptoms
  • The details and severity of work impairments

For more information on how IMCS can help with CA Stress Claims