Psychiatric Treatment - Getting Paid
There exists several aspects of psychiatric injury and or psychiatric treatment. There is the claimed psychiatric injury from
events that happened at work (i.e., harassment, stress, etc.,) and there is psychiatric injury due to the industrial injury itself
(sudden and extraordinary events) and the most widely used is the psychiatric treatment for the consequence of being injured
(i.e., treating the consequence of the orthopedic injury or pain management).
In the 1990s, a practice by some in the industry, caused a significant change in some of the laws addressing psychiatric
injury. What use to happen is that “cappers” or “runners”, use to take a van to the unemployment offices and ask people
standing in line if getting laid off or fired from work caused them emotional distress and when they affirmed the “capper”
would explain to them that filing a workers’ compensation claim would give them more benefits than filing an unemployment
claim. So the van was loaded up and the potential applicants were taken to medical providers who would pay for each
patient and a workers compensation claim was filed. In response to such practice, the post termination defense (Labor Code
§ 3208.3(e) ( put forth herein at the end of this Booklet)) which in summary that psychiatric injury claims filed after
termination, employees must show that the injury was reported to the employer or treated prior to notice of termination,
occurred between notice and separation, was the result of sudden or extraordinary employment events, or there has been a
finding of sexual or racial harassment. Stress associated with a lawful and good faith personnel action will not qualify. In the
case of other types of injuries, the injury must have been reported to the employer before separation or there must be
evidence in the employee's medical records. A post-termination claim would be valid in cases of cumulative trauma or
occupational disease in which the injury did not become apparent until after termination.
However, the practice of the above caused a prejudice for the treatment of psychiatric injury that has just recently turned
around where the law now reflects the need for psychiatric treatment in most cases as reflected in case law that the treatment
of psychiatric consequence of an orthopedic injury is necessary, as from the physical injury itself and or going through the
workers compensation system itself necessities the treatment of the emotional stress and related consequences.
Although there exists three aspects of treatment for psychiatric treatment: (1) psychiatric injury from events that happened
at work (i.e., harassment, stress, etc.,) (2) psychiatric injury due to the industrial injury itself (sudden and extraordinary
events) and (3) psychiatric treatment for the consequence of being injured (i.e., treating the consequence of the orthopedic
injury or pain management), I have found the last of the three of most interest as reflected in the below cited case.
The law recognizes that the consequence of not working due to an industrial injury, and suffering the financial and related
effects of an orthopedic injury does cause the need for psychiatric treatment that is the result of the industrial injury and
therefore the treatment reasonable and necessary. County of Contra Costa v. Workers' Compensation Appeals Bd., 2005
Cal. Wrk. Comp. LEXIS 294; 70 Cal. Comp. Cases 1496 (Cal. App. 1st Dist. 2005)
“The WCJ recommended that reconsideration be denied. In his report, the WCJ noted Defendant's proposition that
Applicant's reaction to his financial difficulties was not an adequate basis to support a finding of a compensable psychiatric
injury. However, he found nothing in Labor Code § 3208.3 or the case law cited by Defendant, which addressed the issue of
whether problems such as financial difficulties, homelessness, and unemployment caused by an industrial injury should be
categorized as industrial or non-industrial causes of the need for psychiatric care. Here, the WCJ pointed out, both reporting
psychologists found that Applicant's psychiatric injury was linked to his psycho-social difficulties, which stemmed from his
industrial injury. Therefore, the WCJ found that the psychiatric injury was proximately caused by Applicant's industrial
injuries and was compensable.”
.
Although there exists three aspects of treatment for psychiatric treatment: (1) psychiatric injury from events that happened
at work (i.e., harassment, stress, etc.,) (2) psychiatric injury due to the industrial injury itself (sudden and extraordinary
events) and (3) psychiatric treatment for the consequence of being injured (i.e., treating the consequence of the orthopedic
injury or pain management).
There exists several aspects of psychiatric injury and or psychiatric treatment. There is the claimed psychiatric injury from
events that happened at work (i.e., harassment, stress, etc.,) and there is psychiatric injury due to the industrial injury itself
(sudden and extraordinary events) and the most widely used is the psychiatric treatment for the consequence of being injured
(i.e., treating the consequence of the orthopedic injury or pain management).
In the 1990s, a practice by some in the industry, caused a significant change in some of the laws addressing psychiatric
injury. What use to happen is that “cappers” or “runners”, use to take a van to the unemployment offices and ask people
standing in line if getting laid off or fired from work caused them emotional distress and when they affirmed the “capper”
would explain to them that filing a workers’ compensation claim would give them more benefits than filing an unemployment
claim. So the van was loaded up and the potential applicants were taken to medical providers who would pay for each
patient and a workers compensation claim was filed. In response to such practice, the post termination defense (Labor Code
§ 3208.3(e) ( put forth herein at the end of this Booklet)) which in summary that psychiatric injury claims filed after
termination, employees must show that the injury was reported to the employer or treated prior to notice of termination,
occurred between notice and separation, was the result of sudden or extraordinary employment events, or there has been a
finding of sexual or racial harassment. Stress associated with a lawful and good faith personnel action will not qualify. In the
case of other types of injuries, the injury must have been reported to the employer before separation or there must be
evidence in the employee's medical records. A post-termination claim would be valid in cases of cumulative trauma or
occupational disease in which the injury did not become apparent until after termination.
However, the practice of the above caused a prejudice for the treatment of psychiatric injury that has just recently turned
around where the law now reflects the need for psychiatric treatment in most cases as reflected in case law that the treatment
of psychiatric consequence of an orthopedic injury is necessary, as from the physical injury itself and or going through the
workers compensation system itself necessities the treatment of the emotional stress and related consequences.
Although there exists three aspects of treatment for psychiatric treatment: (1) psychiatric injury from events that happened
at work (i.e., harassment, stress, etc.,) (2) psychiatric injury due to the industrial injury itself (sudden and extraordinary
events) and (3) psychiatric treatment for the consequence of being injured (i.e., treating the consequence of the orthopedic
injury or pain management), I have found the last of the three of most interest as reflected in the below cited case.
The law recognizes that the consequence of not working due to an industrial injury, and suffering the financial and related
effects of an orthopedic injury does cause the need for psychiatric treatment that is the result of the industrial injury and
therefore the treatment reasonable and necessary. County of Contra Costa v. Workers' Compensation Appeals Bd., 2005
Cal. Wrk. Comp. LEXIS 294; 70 Cal. Comp. Cases 1496 (Cal. App. 1st Dist. 2005)
“The WCJ recommended that reconsideration be denied. In his report, the WCJ noted Defendant's proposition that
Applicant's reaction to his financial difficulties was not an adequate basis to support a finding of a compensable psychiatric
injury. However, he found nothing in Labor Code § 3208.3 or the case law cited by Defendant, which addressed the issue of
whether problems such as financial difficulties, homelessness, and unemployment caused by an industrial injury should be
categorized as industrial or non-industrial causes of the need for psychiatric care. Here, the WCJ pointed out, both reporting
psychologists found that Applicant's psychiatric injury was linked to his psycho-social difficulties, which stemmed from his
industrial injury. Therefore, the WCJ found that the psychiatric injury was proximately caused by Applicant's industrial
injuries and was compensable.”
.
Although there exists three aspects of treatment for psychiatric treatment: (1) psychiatric injury from events that happened
at work (i.e., harassment, stress, etc.,) (2) psychiatric injury due to the industrial injury itself (sudden and extraordinary
events) and (3) psychiatric treatment for the consequence of being injured (i.e., treating the consequence of the orthopedic
injury or pain management).
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