The Standard Used to Determine if a Pschiatric Injury is Compensable in Workers' Compensation Claims Discussed in Hale v. Office of Ins. Comm'r


April 1, 2012
By Lee Law Offices, P.A. on April 1, 2012 7:46 PM |

There is such a stigma surrounding mental health in our society today. It is often overlooked that a totally healthy person can acquire a psychiatric disorder because of stress associated with a physical injury.
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Workers' Compensation ("WC") was created to assist employees when they are injured because of work related activity. Our experienced Carolina injury attorneys understand the implications of these injuries and we can help get you get the relief you deserve in your North and South Carolina workers' compensation case.

Hale is a West Virginia case involving a critical question in WC claims. The court not only clarifies, it decides that a claimant is not required to seek approval from their claim administrator to seek a psychiatric evaluation. However, the court does cite important case law that dictates the required process for claiming a psychiatric injury as a compensable injury in WC claims.

Hale v. Office of Ins. Comm'r arose where Hale ("Claimant") worked for the West Virginia Office of Insurance Commissioner ("Defendant"). During the course of his employment, Hale suffered injuries to his back. Because of these back injuries, claimant petitioned for WC benefits and received a permanent partial disability award. As a result of claimant's injuries, he suffered an increase in anxiety and depression. This led the claimant to seek the assistance of a psychiatrist. The psychiatrist evaluated the claimant and found that the claimant was suffering with a major depressive episode directly related to his back injuries.

Upon the conclusion that there was a causal link between claimant's back injury and claimant's depression, the psychiatrist entered a request to have these mental illnesses be added as a compensable injury to the claimants existing WC claim. In addition to this request, the psychiatrist forwarded all of the records relating to that evaluation to the WC claim administrator.

Once the documents were received, the Worker's Compensation Board of Review ("BOR") and the WC Office of the Judge ("OOJ") rejected this addition to claimant's injuries. They argued that the depression and anxiety did not present itself within six months of the back injury; therefore, the causal link was implausible. Furthermore, the BOR and OJJ held that in order to seek a psychiatric evaluation all claimants must first seek approval from their WC claim administrator. Unhappy with this result, the claimant appealed these decisions to the appropriate court.

Thus the court in this case focused primarily on the question of whether a claimant was required to first seek approval from a WC claim administrator before seeking a psychiatric evaluation.

In WC cases, the claimant is responsible for proving all of the elements of the claim. A request for benefits must be supported with evidence of a personal injury that was the result of their employment and the personal injury was sustained during the performance of tasks associated with claimant's employment.

In order to analyze a question of law in WC cases, the court must look to state WC laws. In so doings, this West Virginia court found that there were two conflicting statutes. Thus, the court had to analyse both statutes and determine which was incorrect. In order to do this, courts look to legislative history and legislative intent.

Workers' Compensation was created by an administrative agency in order to provide benefits to workers who are injured as a result of their employment. Therefore, the court is required to uphold these rules and procedures except where the statute is unreasonable and where the statute changes a claimant's substantive rights. See State ex rel. Callaghan v. W.Wa. Civil Serv. Comm'n, 273 S.E.2d 72 (1980).

The court then found that the WC statute requiring claimants to first petition their claims administrator before they sought a psychiatric evaluation, were unreasonable and inconsistent with the legislative intent. To allow that requirement would have been an invalid exercise of administrative regulation.

The court in Hale held that it is not within the rights of a claim representative to decide whether a claimant should seek psychiatric help. Instead, the court looked to prior case law and the other statute in the citing of the state rules surrounding this question.

In order to comply with WC statute in cases involving psychiatric evaluations, first the claimant's primary physician must recommend that claimant seek a psychiatric evaluation. The records from the evaluation must be forwarded to the WC claim administrator. Then the WC claim administrator can make an informed decision as to whether the claimant should be able to add any mental illness as a compensable injury in their claim.

This case pushes WC claim administrators out of the business of making uninformed decisions regarding mental health benefits.

If you, someone you work with or someone you love has been injured in an accident on the job or needs to file a workers' compensation claim in North Carolina, contact the Carolina injury attorneys at the Lee Law Offices today for a free and confidential appointment to discuss your rights. Call 800-887-1965.