Does Workers’ Compensation Cover PTSD?

Knowing how post-traumatic stress disorder (PTSD) is defined and how your state’s work comp laws address it can help you make sure your employees get the help they need.

It’s common to think of PTSD in connection with military personnel; however, anyone who has been exposed to a traumatic experience can suffer from PTSD. Most cases of work-related PTSD come from high-risk occupations, such as police officers, firefighters and emergency medical crews. However, any dangerous environment can bring about PTSD symptoms if an event causes psychological trauma.

Recognizing PTSD

According to the National Alliance on Mental Health, PTSD symptoms include:

• Repeatedly reliving the trauma through flashbacks, hallucinations and nightmares.
• Avoiding anything that may remind him or her of the trauma, including people and places.
• Excessive emotions, problems relating to others, sleeping disorders, irritability or difficulty concentrating.
• Negative cognitions and mood related to blame, estrangement and memories of the event.

For workers’ compensation, the PTSD must be work-related

Workers’ compensation is meant to help people who have been injured while performing their job. While the rules regarding PTSD are somewhat vague, claims involving mental illness are classified into three categories:

• Physical-mental refers to cases in which mental stress produces physical injury. For example, if an employee was seriously injured at work and suffers from PTSD as a result, his condition would be described as physical-mental.
• Mental-physical refers to cases in which physical trauma produces mental injury. For example, if an employee developed PTSD that later leads to high blood pressure and ulcers, his condition would be considered mental-physical.
• Mental-mental refers to cases in which mental stress produces mental injury. For example, if an employee witnessed a horrific accident at work and developed anxiety and PTSD as a result, his condition would be considered mental-mental.

State workers’ compensations laws vary in their treatment of PTSD claims. Generally, states handling of PTSD workers’ compensation claims fall into one of the following categories:

• In many states, workers’ compensation covers PTSD claims only if certain kinds of extraordinary events caused them.
• Several states will not award any workers’ compensation benefits for mental-mental claims.
• In some states, mental-mental cases are compensable, but only if the mental stimulus is sudden.
• A few states allow claims for psychological conditions caused by stress at work, even if it’s gradual and not unusual for the job.

In states where PTSD is a compensable workers’ compensation injury, the post-traumatic stress disorder must be diagnosed by a licensed psychiatrist or psychologist. The PTSD must also meet the criteria described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

In Iowa, if the authorized treating physician in the workers’ compensation case states that the current condition and treatment for PTSD is work related, then treatment will be authorized. It’s important to note that the work condition and circumstances leading to the mental health condition must exceed that which is typically experienced by peers in the same profession.

Assisting employees with PTSD

PTSD is not diagnosed until at least 30 days after a traumatic event has occurred; however, early intervention can help prevent anxiety from progressing to PTSD. Employers can take some basic steps to help:

• Watch for signs of stress among employees.
• Make an employee assistance program (EAP) available so that employees have access to help.
• In the event of severe workplace trauma, arrange for on-site intervention and counseling services.

Juli Jenkins is a client service executive at LMC Insurance and Risk Management in West Des Moines, Iowa. Contact her via email at juli.jenkins@lmcins.com.