The perception about workers’ compensation coverage is generally limited to physical injuries like a broken bone or back injury; however, in certain limited circumstances, mental health conditions like post-traumatic stress disorder are also covered under workers’ compensation benefits.
The difficulty is, proving a PTSD claim is much more complex than simply walking in with X-rays of a broken arm.
Insurance companies are often predisposed to doubt paid claims related to mental health, and as a victim of a traumatic event at work, typically you (the claimant) will bear the burden of proof, which means you will have to prove your PTSD is related to an event that occurred at work; which means you will need evidence, which means collecting good evidence, which means good medical documentation, which often includes good expert opinions.
If you are having difficulty coping after experiencing a traumatic event at or related to work, and are wondering how to navigate this process to access the assistance you need, then here is what you absolutely must understand about how to prove PTSD in workers’ compensation claim.
Understand how PTSD qualifies for workers’ comp
First you need to understand that PTSD is not automatically covered by workers’ compensation law for every mental health diagnosis; you cannot just state that you have a stressful job. There must be a concrete and direct link between a specific traumatic event in the workplace and the subsequent PTSD diagnosis.
Workers’ compensation recognizes PTSD most often for cases of workplace violence, serious workplace accidents that you were a bystander or participant, or situations in which you had repeated exposure to the same event. Think first responders, health care workers treating tragic cases, or workers that survived an incident such as a workplace shooting or serious accident.
The requirements are different from state to state. Some states have fairly strict requirements making it impossible for mental health claims to be approved and other states have fewer requirements and are more liberal in accepting cases for psychological injury. You need to take time to know what your state requires because it will affect your approach to establishing your case.
In some states there is a requirement that the traumatic incident has to be sudden and unexpected versus other states may accept a lifetime disability claim based on being exposed to multiple incidents of traumatic exposure over a period time (i.e., long-term employees).
Understanding what your state requires will allow you to frame your claim in as strong a manner as possible.
Seek medical attention urgently
Obtaining urgent medical treatment is equally important to your health and your workers comp claim. The sooner you receive a proper PTSD diagnosis by a perform PTSD you will have the strongest possible claim for the disorder you are experiencing.
It will be important that you see someone who is a qualified mental health professional that has experience diagnosing and treating PTSD. Your insurance company will scrutinize your medical records, and a diagnosis from someone recognized as an expert will weigh much beyond a diagnosis made from someone who does not have expertise in trauma.
Additionally, document everything thoroughly. All of your symptoms, all of your diagnosis, all of your treatments received, medications prescribed, and your responses from different treatment options. This documentation will form the basis of your claim.
Follow your doctor’s treatment protocol fully and consistently. If you miss appointments or do not follow your prescribed treatment, the insurance company may assert that your condition cannot be that serious or that you are not committed to improving your condition.
Document how PTSD impacts your work and life
Insurance companies will want to see demonstrable evidence of how PTSD actually impacts your ability to function at work and in your personal life. Start to keep a careful journal of your symptoms, what triggers those symptoms, and how those symptoms flash and interject into your daily living.
And, be sure to make a detailed record of specific changes in your work abilities or concentration. Are you making more errors? Have they noticed you seem distracted in meetings? Are you avoiding certain areas of your workplace? Are you unable to complete tasks that you considered routine? Document it.
PTSD impairs sleep patterns, personal relationships, and also general daily living tasks such as driving or going into crowded spaces. Do not forget to document these areas of your life as well, as they all contribute to a picture of how the condition is affecting your lifestyle.
Be consistent in the information you provide your doctor, employer, and any attorney. Variances in the information you give give insurance companies more than enough reason to deny your claim, or to argue you are exaggerating the extent of your symptoms.
Fight for your mental health
Proving the existence of PTSD in a workers’ compensation claim does involve more than just retelling a story, it encompasses fundamentals in providing evidence, complete contemporaneous records from your medical files, and an irrefutable link between your condition and the labour relations incident. Although the whole process might feel like overwhelmed when you are living the aftermath of many trauma symptoms, acknowledging that there are important steps to take, and following a sound strategy could make all the difference in entitlement to the parties benefits you are owed and ultimately, apply them towards your recovery.
If you are developing PTSD following a traumatic incident due to workplace events, there is nothing wrong with acquiring medical treatment and seriously considering legal representation. Your mental health is as essential as your physical health. You do have the right to seek assistance and compensation as you recover.
Keep in mind, PTSD is an actual and serious condition, that can be as disabling as any physical injury. Do not let the insurance company diminish or deem worthy of the barriers to getting the help you need to recover and get on with your life.
Ellen Diamond, a psychology graduate from the University of Hertfordshire, has a keen interest in the fields of mental health, wellness, and lifestyle.
