When is PTSD covered by workers’ compensation?

When an employee experiences a traumatic event at work, workers’ compensation coverage is probably the last thing on your mind. But knowing how post-traumatic stress disorder is defined and covered in your state can help you make sure your employee gets needed help.

For PTSD to be covered by workers’ compensation, it must meet the criteria as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, and be diagnosed by a psychologist or psychiatrist.

By definition, symptoms must last or start a month or more after the event to be considered PTSD. Symptoms that last less than a month are considered acute stress disorder. This nuance is important when it comes to how different states handle PTSD claims.

Some states specifically address PTSD in their workers’ compensation laws. In other states, whether PTSD is covered depends on what caused it and whether the state recognizes that event as a work injury.

If the event that led to PTSD was physical, most states will recognize that as a physical/mental injury (that is, a mental injury caused by physical injury) and treatment for PTSD will be compensable. If the employee was involved in a traumatic event, but there was no physical injury, some states may not recognize PTSD as a claim. This is referred to as a mental/mental injury.

Here are the specifics on PTSD in SFM’s core states:

  • Minnesota
    PTSD is specifically addressed in the statute. If an employee is diagnosed with PTSD by a licensed physician or psychologist and the employee meets the Diagnostic and Statistical Manual of Mental Disorders criteria, the claim is covered by workers’ compensation benefits. This is the only type of mental/mental claim recognized in Minnesota. If PTSD is diagnosed as arising from a physical injury, that would be compensable in Minnesota as a physical/mental claim.

    For injuries occurring after January 1, 2019, it will be a presumption that PTSD in first responders is compensable under workers’ compensation, absent preexisting history and limited statutory exceptions. PTSD claimed due to job performance issues, such as demotions and layoffs, is not compensable.

  • Wisconsin
    PTSD is not specifically addressed in the statute. Mental/mental injuries can potentially be compensable if the circumstances causing the injury arise from extraordinary stress. It must be a far greater stress than the expected emotional strain that employees encounter daily without serious mental injury.
  • Iowa
    Mental/mental injuries are recognized, but in order to be compensable under Iowa law, the work condition and circumstances lead­ing to the mental condition must exceed that which is typically experienced by peers in that same profession. PTSD may be compensable without any physical injury to the body under these circumstances.
  • Nebraska
    Mental/mental injuries are not compensable in Nebraska, so a diagnosis of PTSD without any physical injury would typically not be covered. If there is a physical injury to the body and PTSD is a condition that is a result of that injury, it could be compensable as a physical/mental injury.

    However, first responders are an exception. PTSD could be compensable as a mental/mental injury for first responders who are exposed to extraordinary and un­usual stimuli in comparison to normal conditions of their employment. Nebraska statute defines first responders as sheriffs, deputy sheriffs, police officers, state patrol troopers, volunteer or paid firefighters, emer­­gency medical technicians and paramedics.

  • South Dakota
    South Dakota does not cover mental/mental injuries. There must be a physical injury to the body. If an employee sustains a physical injury and claims PTSD as a consequential injury, then it could be compensable.

Intervene early to help employees who've experienced trauma

Although PTSD cannot be diagnosed until 30 days after a traumatic event, you shouldn’t wait that long to reach out to your employee. Early intervention can prevent situational anxiety from progressing to PTSD. Encourage any employee who may be susceptible to seek help through your employee assistance program, SFM’s Injured Worker and Family Assistance Program or from a psychologist or psychiatrist.

“If someone has experienced trauma, be it physical or mental, coping skills for them to be more resilient so they can manage their stress and anxiety is what’s going to get them better,” said Director of Medical Services Ceil Jung, RN, BSN, CCM. “Treatment is typically cognitive behavioral therapy (CBT). Symptoms can usually be effectively managed to restore the individual to normal functioning.”

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