California Workers’ Comp: Recovering for Mental or Emotional Injuries

Learn about the special rules in California that apply to workers’ comp claims for psychiatric injuries.

If you’re suffering from emotional or mental problems because of your job in California, you might be considering filing a workers’ compensation claim. Unlike some other states, California covers “psychiatric injuries” (as the law calls them) in its workers’ comp system. But employers and insurance companies routinely deny workers’ comp claims for psychological conditions like depression and anxiety. Lawmakers are also skeptical of these claims, so they’ve added special rules for psychiatric injuries. In other words, you’ll probably have to jump through additional hoops to prove that your psychiatric injury or illness is work-related and that you’re entitled to workers’ comp benefits.

Psychiatric Injuries: Special Workers’ Comp Requirements

A work injury that is purely psychological is sometimes referred to as a “stress claim” or a “mental-mental claim.” In these cases, an employee has suffered mental or emotional injuries, usually as a result of stressful conditions at work. These injuries may force workers to take time off work and may leave them unable to perform certain tasks, such as concentrating at work or communicating with others. For example, if you suffer a mental breakdown after being overworked to the point of exhaustion or subjected to threats at work, your condition might qualify as a psychiatric injury under workers’ comp.

However, the California workers’ comp system treats psychiatric injuries differently than physical injuries. There are a couple of rationales behind this. First, psychological injuries are based on employees’ internal experiences (that is, their thoughts and feelings). There aren’t good objective tests to detect and measure those experiences, like blood tests or x-rays that reveal physical injuries or illnesses. So when employees say they’ve suffered a psychiatric injury, it’s hard for doctors to verify their claims. Second, psychological conditions can have many causes, including a variety of personal reasons that have nothing to do with work, like marital or financial troubles. Employers and insurance companies argued for years that it was too easy to fake a psychiatric injury or blame an emotional condition on work when it really resulted from the employee’s general life condition.

As a result, you must meet all of the following requirements in order to receive benefits for a psychiatric injury:

  • You must have a “mental disorder” that’s been diagnosed under accepted procedures.
  • As a result of your mental disorder, you must have required medical treatment or experienced disability (meaning that you had to miss work or couldn’t do some of your work tasks).
  • You must have worked for your employer for at least six months (not necessarily continuous), unless your psychiatric injury resulted from a sudden, extraordinary condition at work.
  • You must prove that “actual events of employment” were the “predominant” cause of your psychiatric injury—meaning that when all the causes are taken into account, working conditions were at least 51% responsible. (The standard is lower—35% to 40%—if you were a victim of violence at work or you were directly exposed to a “significant violent act.”)

(Cal. Labor Code § 3208.3 (2018).)

The last requirement essentially means you need to show that other, personal struggles in your life weren’t the main cause of your emotional or psychological condition. That, in turn, means that your private life will be scrutinized, with the insurance company (or independent medical evaluators) digging for anything else that could have contributed to your condition, including family or financial troubles, a history of mental illness, past or current drug use, criminal history, and other sensitive issues.

What Are Actual Employment Events?

The “actual events of employment” requirement may also pose a hurdle for your psychiatric injury claim. For example, it probably won’t count if you’re anxious about your employer’s financial condition, downsizing, or stock loss. Also, stress caused by the workers’ comp process itself (when you had a previous claim) won’t qualify as a work-related injury.

Stress From Personnel Actions and After Layoff Notices

Your claim could also be denied if:

  • your employer proves that a good-faith, nondiscriminatory personnel action (such as legitimate criticism of your work performance or the denial of a promotion) was largely responsible (at least 35% to 40%) for your psychiatric injury
  • you filed your claim after receiving notice that you were being laid off or fired, unless your injuries were the result of sudden and extraordinary workplace events or you qualify for one of the other limited exceptions.

(Cal. Labor Code § 3208.3(e), (h) (2018).)

Workers’ Comp Benefits for Psychiatric Injuries

In addition to the strict requirements for proving that you have a work-related psychiatric injury, your benefits will usually be more limited than they would be for physical injuries. You’ll probably be entitled to payments for medical treatment of your condition and temporary disability benefits if you had to take time off work. However, it will be more difficult to get permanent disability benefits for a mental or emotional condition. This is because once you leave the stressful work environment, it’s assumed that you will fully recover and be able to find a new job. (For more information on the types of benefits you can receive, see How Workers’ Compensation Payments Are Calculated for Injured Employees in California.)

When Work-Related Physical Injuries Cause Psychiatric Injuries

If you suffered a psychiatric injury as a result of a physical work-related injury rather than job stress, you’ll generally have an easier time proving that your mental or emotional condition is work-related (even though the rules described above still apply). For example, suppose you suffer a serious back injury at work and become depressed after months of being laid up in bed, in considerable pain. Because depression commonly occurs in people dealing with chronic pain and disability, it will be easier to link the mental condition to the work-related incident.

These types of injuries are also called “compensable consequence” injuries because the psychiatric injury is the consequence of the physical injury. Other types of possible compensable consequence injuries include anxiety, sleep disorders, and sexual dysfunction resulting from a physical injury.

As with other types of work-related psychiatric injuries, you may be entitled to medical treatment and temporary disability benefits. However, you won’t be able to receive any permanent disability benefits for psychiatric injuries that are a compensable consequence of a physical injury unless:

  • you were the victim of a violent act at work or were exposed to significant work-related violence
  • your original physical injury was catastrophic (such as severe head injury or burns), or
  • your injury happened before 2013.

(Cal. Labor Code § 4600.1(c) (2018).)

Consult With a Lawyer

Because psychiatric injuries are subject to complex workers’ compensation laws, you should consult with a lawyer about your claim. Workers who suffer from mental or emotional injuries often face uphill battles against skeptical insurance companies who are ready to deny these types of claims. To get connected with a workers’ comp lawyer in your area, fill out our free case evaluation form.

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