June 2015

PTSD is a psychological syndrome that can affect a person of any age. PTSD can occur after living through or seeing a traumatic event, such as war, a hurricane, sexual assault, physical abuse or a bad accident. Signs of PTSD may start soon after the event and then continue. Other people develop new or more severe signs months or even years later.

PTSD makes people feel stressed and afraid after the danger is over, affecting their lives and the lives of those around them. It can cause problems such as:

• Flashbacks, or feeling like the event is happening again
• Trouble sleeping or nightmares
• Feeling alone
• Angry outbursts
• Feeling worried, guilty or sad.

An employee with PTSD is more likely to suffer mental stress from a workplace incident than other employees. However, PTSD differs from other "co-morbid" conditions, such as obesity, a prior injury or seizures, which make a person more prone to accident or health problems. Unlike those other conditions, PTSD is not easily visible and often undiagnosed. 

Employers take their employees as they are, past experiences and all. If your worker has a work-related injury, your workers’ compensation would cover it, even if he had condition that made him more prone to injury. For example, let’s say an overweight warehouse worker developed knee problems from too much bending. If he could prove the job caused his injury, your workers’ compensation would have to pay — even if his obesity made him more prone to joint problems. It’s the same with PTSD — just because a worker suffered from mental stress employment does not mean that his condition is not compensable.

Sometimes physical trauma, such as an assault or injury, can trigger episodes of PTSD. Sometimes they happen due to mental stimulus, such as harassment or other stressful events with no physical injury.

In some states, workers’ compensation only covers mental stress claims, including PTSD, if the stress results from a physical injury. Other states will compensate so-called "mental-mental" claims.

California workers’ compensation might cover a mental stress claim if it meets certain conditions. The employee must have worked for the employer for at least six months. He or she must have a diagnosed mental condition that causes a disability or need for medical treatment. Finally, a claimant must prove that work conditions were at least a 51 percent contributor to the mental stress injury.

If a traumatic or violent event happens at work, employees who suffer immediate emotional stress may have claims that would be denied under normal work conditions. Some state regulations explicitly address violence, and in other states, court rulings have established precedents for dealing with claims that stem from violent acts. In California, victims of workplace violence only have to prove that work conditions were 35 percent responsible for their mental injuries.

With a stress claim, the employee’s overall mental health and his or her personal life may become relevant. This is a sensitive area that a claims professional should handle. For more information on handling PTSD and other mental stress claims, please contact the PCOC Insurance Program department of EPIC at (877) 860-7378 or, email us @ ProPest@epicbrokers.com. Also check out: www.pcocinsurance.com.