Generally, when a person has an accident at work and sustains a physical injury, absent a few exceptions, the result is usually compensable. However, if a person is involved in an on-the-job injury, which results in a “psychological” injury, there is a question whether this injury should be deemed compensable under the Workers’ Compensation Act.
Generally, when a person has an accident at work and sustains a physical injury, absent a few exceptions, the result is usually compensable. However, if a person is involved in an on-the-job injury, which results in a “psychological” injury, there is a question whether this injury should be deemed compensable under the Workers’ Compensation Act. There is a difference of opinion throughout the United States. Some states deem a mental injury to be just as compensable as a physical injury and hold the Employer/Insurer responsible for all medical treatment related to such. Georgia Courts have long held that when there is a physical injury, and the claimant’s disability is aggravated or prolonged by a psychological component of the injury, the affects of the psychological injury are generally compensable. Indemnity Ins. Co. of North America v. Loftis, 103 Ga. App. 749, 120 S.E.2d 655 (1961). However, if psychotic trauma is not preceded or accompanied by a physical injury, it is not compensable. Abernathy v. City of Albany, 269 Ga. App. 88, 495 S.E.2d 13 (1998). In Georgia, it continues to be clear that unless a psychological injury is preceded or accompanied by a physical injury, such psychological injury is not compensable. Although the State of Georgia continues to follow this law, other states have begun to change their legal views based upon the changes in the medical profession regarding psychiatric treatment and the development of depression causally related to workplace injuries.
In a recent case, in the State of Texas, a state employee stumbled over a threshold at her place of employment in 1999 and injured her back. Due to such, she began to feel intense pain in her low back and underwent numerous back and spinal surgeries, which were covered by workers’ compensation. In conjunction with treatment for her physical injuries, the employee was referred to visit a psychiatrist for treatment of depression. The psychiatrist in this matter ultimately attributed her depression to her work-related injury. Subsequently, such employee received workers’ compensation benefits for her physical and psychological conditions, but after five months of psychiatric treatment, the State Office of Risk Management (SORM), which handles state employee workers’ compensation claims disallowed payment for further psychiatric treatment. Although the psychiatrist stated that the employee’s symptoms of depression, in part, continued to be related to her workers’ compensation injury, SORM denied payment for continued treatment. The state employee appealed the denial. During the hearing, both parties agreed that the claimant sustained a compensable, work-related back injury, but the parties disagreed about the extension of that injury to include depression. SORM presented evidence to the court that the state employee’s depression began in her teens, and that she had been hospitalized for depression two or three times before her work injury and had been under the care of several psychiatrists over the years. Additionally, SORM presented evidence that the state employee was experiencing non-work-related stressors in her life, including learning of her father’s terminal lung disease, dealing with her husband’s drug abuse and experiencing marital difficulties. Although SORM presented many different factors which could contribute to and explain the claimant’s depression, the Texas Court found that her compensable injury included the development of her depression. Based on such ruling, the employee has been allowed to continue her psychiatric treatment at the expense of the Employer/Insurer. SORM v. Baker, Court of Appeals of Texas, 11th District, Eastland, No. 11-05-04417-CV (1/4/08).
If this Texas case represents the future of handling psychological injuries in the workers’ compensation arena, this presents an uphill battle for employers and insurers to separate non-work-related stressors from the stressors/depression that develops after a compensable, physical work-related injury.
Texas is not alone in its liberal stance on the compensability of depression. The Supreme Court of Wyoming awarded workers’ compensation benefits to an employee for medical expenses and disability caused by his attempt to take his own life. The employee in this case suffered a back injury while at work. After such injury, all parties agreed that the injury was compensable and that the claimant was entitled to medical and indemnity benefits at the expense of the Employer/Insurer. As we are aware, back injuries cause employees a substantial amount of pain which results in an inability to return to work. In this particular case, after being out of work for a substantial amount of time, the employee fell into a depression and later attempted suicide by shooting himself. After the employee’s suicide attempt, the employee’s counsel argued that the Employer/Insurer should be responsible for the claimant’s medical treatment stemming from the self-inflicted gunshot wound. As the parties did not agree, the claim proceeded to a hearing wherein the employee presented evidence of a psychologist who supported the employee’s allegations that his depression and attempted suicide were causally related to his physical work-related injury. At the initial hearing, the court did not agree with the claimant and sided with the Employer/Insurer, which was affirmed at the Appellate Division. However, on appeal to the Supreme Court, the previous rulings were reversed. The Supreme Court held that, but for the compensable work-related, physical injury, the claimant would not have fallen into a depression, which later led to his suicide attempt. Therefore, the Employer/Insurer had to pick up the cost of the claimant’s self-inflicted gunshot wound and future treatment. National Council on Compensation Insurance.
To employers and insurers, the notion that an Employer/Insurer should be held responsible for an employee’s attempt at suicide or, to take it one step further, the Employer/Insurer being held responsible for death benefits for an employee who commits suicide after a compensable work-related injury seems absurd. However, more and more states are beginning to hear these types of claims, which have resulted in few, but similar, conclusions of law.
In the State of Georgia, treating physicians are beginning to prescribe anti-depressant medication to claimants alongside their treatment for the work-related physical treatment. Oftentimes, they state that, in their medical opinion, the depression is causally related to the work injury. If this continues to occur, more and more, Employer/Insurers will be faced with providing – at their expense – psychiatric treatment to a claimant who has developed depression during treatment for a compensable, physical work-related injury. The question becomes, for how long will the Employer/Insurer have to continue payment for such treatment and to what extent will the Employer/Insurer be responsible if a claimant goes as far as to attempt or commit suicide? To prepare for things to come, at the onset of a treating physician’s diagnosis of possible depression, first controvert the treatment if you deem it not to be related. The next step is to thoroughly investigate the claimant’s past medical history to determine whether there is a history of psychological trauma and, if so, collect evidence of such history and reasons for such trauma. If the Employer/Insurer are able to present a substantial amount of medical evidence depicting that the claimant had a history of non-work-related stressors that led to a depression diagnosis and treatment for such, it would place us in a better position to argue that this depression is not related and does not aggravate or prolong the claimant’s disability caused by his work-related, physical injury.
Based upon Georgia law, the Employer/Insurer continue to be secure in its defenses against compensability of mental injuries. However, we must continue to be mindful of the changes in other states and in the medical field. In the psychiatric field, there is a view that, in the workers’ compensation arena, the courts have tended to blame the employee for the disability of depression rather than considering the role that the physical injury plays or the role that workplace stress plays. Due to such, the psychiatric field believes that judges who seek to blame workers for their own depression do not recognize the rehabilitative purposes of workers’ compensation law. Psychiatric Services, December 2001, Vol. 52, No. 12, p. 1641. The psychiatric field believes the rationale behind the blame-seeking analysis seems to stem in part from judicial concerns about the possibility of workers’ compensation being turned into a general health insurance system. Further, they feel judges are concerned that claimant’s would wrongly get money for lost wages and treatment for depression when the ailment actually arises out of the “day-to-day emotional strain and tension which all employees must experience.” Psychiatric Services, December 2001, Vol. 52, No. 12, p. 1641.
Although there is no clear view as to what is to come Georgia’s future with regards to the causal relationship between a compensable, physical injury and the development of a psychological condition, we, in Georgia, must be mindful of how other states are beginning to handle psychological injuries in the workers’ compensation arena. Additionally, with the medical profession becoming more vocal and readily willing to diagnose depression, we should be prepared to face more of these issues in the future.