Does Workers’ Compensation Cover Mental Injuries?

Does Workers' Compensation Cover Mental Injuries?

Most workers’ compensation claims secure benefits for injured workers who receive physical injuries on the job. But in some circumstances, the Virginia Workers’ Compensation Act also provides benefits for work-related mental injuries. A mental injury workers’ comp claim is legally and factually complex — and establishing entitlement to benefits is considerably more challenging than making a claim for a physical injury.

Mental Injury Claims Under the Virginia Workers’ Compensation Act

To succeed in a workers’ comp mental injury claim in Virginia, a worker must establish that the Commonwealth’s Workers’ Compensation Act entitles the worker to benefits for the injury. With one exception for PTSD in law enforcement officers and firefighters, which is discussed in detail below, the statute does not contain specific provisions that apply to mental injury claims. Entitlement to benefits must be established under the general provisions of the Act that apply to claims.

The primary relevant provision is the definition of the term injury contained in the statute. That definition determines whether an injury is compensable under the statute. In part, the definition states that a compensable injury includes “only injury by accident arising out of and in the course of the employment or occupational disease as defined in Chapter 4 (§ 65.2-400 et seq.) and does not include a disease in any form, except when it results naturally and unavoidably from either of the foregoing causes.”

Taking this definition and other applicable provisions of the Act into account, there are four types of mental injury claims that may qualify for workers’ compensation benefits: 1) Mental injuries resulting from a compensable on-the-job physical injury; 2) Mental injuries that qualify as an occupational disease; 3) Mental injuries arising out of a single specific incident that does not cause a physical injury; 4) PTSD (Post-Traumatic Stress Disorder) that qualifies as compensable under recently-added provisions in the Act that apply to PTSD of law enforcement officers and firefighters.

Unless a mental injury falls into one of these categories, it probably will not be compensable under the Virginia workers’ comp law. Ordinary mental stress and anxiety that exist in the workplace or arise because of job responsibilities do not typically qualify as a compensable mental injury.

Every situation is unique. The only way to determine whether a mental injury may qualify for workers’ comp benefits is to consult with a knowledgeable workers’ comp attorney, who can analyze the circumstances and make legal and factual evaluations about whether there is a basis for a claim. Our Richmond workers’ compensation attorneys at Renfro & Renfro assist clients with all types of workers’ comp claims, including claims for mental injuries.

Mental Injury Resulting from a Work-Related Physical Injury

If a worker develops mental health issues as the result of a physical injury that qualifies for workers’ compensation benefits, the worker may be able to recover benefits for the mental injury. Psychological issues following a physical injury are not uncommon.  Following a traumatic injury people often suffer from PTSD, depression or anxiety related to the accident.

The key to recovering benefits is establishing that the mental injury resulted from the physical injury, and not from something else. Proving that fact usually requires specific evaluation and evidence from a medical professional, possibly even a qualified mental health medical professional like a psychiatrist or psychologist. Assistance from a knowledgeable workers’ compensation lawyer is essential to succeeding with this type of claim.

Mental Injury as an Occupational Disease

A worker employed in a particularly high stress occupation may be able to claim workers’ comp benefits for a mental injury on the basis that it is an occupational disease. If a job involves repeated exposure to stressors that eventually cause mental health issues, the worker may be able to demonstrate that the issues qualify as an occupational disease under the Act.

Provisions of the Act found at Virginia Code § 65.2-401 establish criteria for ordinary disease of life coverage as an occupational disease. Among the requirements is that the disease arises in the course of employment and not from causes outside employment. The section also provides that the mental injury must be the result of conditions peculiar to the employment.

While Virginia court cases recognize that a physical injury may not be a prerequisite to recovering workers’ compensation benefits for psychological injury, establishing a case for this type of claim is extremely challenging. A worker should not attempt to pursue a claim of this nature without consulting with an experienced Virginia workers’ compensation attorney.

Mental Injury Arising Out of a Specific Incident

In some circumstances, a worker who suffers psychological effects from an incident that occurs in the scope of work may be able to recover benefits, even if the worker did not suffer a physical injury from the incident. Like other types of mental injury claims, this type of workers’ compensation claim is difficult to establish, particularly in view of Virginia court decisions addressing the issue. For that reason, a worker who may have this type of mental injury claim should talk with a workers’ comp lawyer before pursuing the claim.

PTSD Claims of Virginia Law Enforcement Officers and Firefighters

In 2020, the Virginia Legislature and Governor enacted a new section of the Virginia Workers’ Compensation Act that governs coverage for post-traumatic stress disorder or PTSD for first responders. The new section, found at Virginia Code § 65.2-107, provides workers’ comp benefits for Virginia firefighters and law enforcement officers experiencing PTSD as the result of qualifying events, which include incidents or exposure occurring in the line of duty on or after July 1, 2020.

The section defines which individuals qualify by virtue of their position, as well as what constitutes a qualifying event. The provision requires examination and a diagnosis of PTSD by a mental health professional for a claim to be compensable. The statute also addresses the benefits that are available.

If you are a law enforcement officer or firefighter with a potential claim under this new section of the Virginia Workers’ Compensation Act, you should consult with an experienced workers’ comp lawyer before pursuing your claim. The provisions of the new section are detailed and complex. A lawyer should complete a thorough legal and factual analysis of your situation to ensure that your claim meets the requirements and complies with all the criteria of the statute.

Making a Mental Injury Claim Under the Virginia Workers’ Compensation Act

Filing a workers’ comp claim for mental injury requires the same process as a claim for a physical injury. If a claim is approved, the worker receives the same benefits as for a physical injury. However, succeeding in a mental injury claim is much more difficult than pursuing benefits for a physical injury. Your insurance company is unlikely to be favorably inclined when reviewing your mental injury claim. Any mental injury claim presents legal and factual challenges.

Every individual situation involving a potential mental injury claim is unique. Your claim needs to be analyzed under the complex legal principles that apply before you file, in order to maximize your chances of success.

Before you file, you should consult with legal counsel thoroughly familiar with Virginia workers’ compensation laws and court decisions that apply to this type of workers’ comp claim. After learning the details about your circumstances, your lawyer will evaluate your claim. If you then decide to proceed with the claim, your lawyer knows how to face and overcome the legal hurdles that your mental injury claim presents.

Schedule a Free Consultation with an Experienced Richmond, Virginia Workers’ Compensation Lawyer

Pursuing a workers’ comp claim can be extremely frustrating and confusing for an injured worker. Mental injury claims raise especially difficult challenges and questions, because the applicable Virginia law is very complex. At the Richmond law firm of Renfro & Renfro, our dedicated workers’ compensation lawyers help clients with all types of Virginia workers’ compensation claims, including those for a mental injury. We welcome you to contact us for a free consultation.


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