While post-traumatic stress disorder (PTSD) is often associated with military veterans, it can arise in other traumatic situations. People in certain occupations, such as police and first responders, face extreme levels of stress that are inherent to their job. However, anyone may be at risk of developing PTSD upon witnessing the death or serious injury of someone else, or an incident of sexual violence. They may struggle for years with depression, flashbacks, insomnia, migraines, and severe reactions to any triggers that remind them of the traumatic event.
If you succeed in a workers’ compensation claim based on PTSD, you should get coverage for your medical treatment. In some states, you may also receive wage replacement benefits based on any permanent or temporary disability related to the PTSD. These claims tend to be challenging, though, since workers’ compensation systems usually are designed to address physical conditions more than psychological conditions.
Restrictions on PTSD Claims
Some states allow people suffering from job-related PTSD to receive benefits only if the PTSD resulted from a certain type of situation. This usually needs to be an event that was extraordinary and unforeseeable, considering the job duties of the employee. As a result, certain types of first responders might not be able to collect benefits for PTSD because their job routinely exposes them to traumatic situations.
Did You Know?
In some states, a worker may only receive compensation if their PTSD is connected to a physical injury.
In other states, a workers’ compensation claim based on PTSD will succeed only if the claimant can show that the PTSD was connected to a physical injury. States that use this rule may carve out exceptions for certain professions, such as law enforcement. Still other states permit benefits for PTSD only if the worker’s job was the predominant cause of the PTSD. This means that it must have been more than 50 percent responsible for the condition. Sometimes additional technical requirements may apply.
Recent trends suggest that people suffering from PTSD may have a stronger chance of obtaining benefits in the future. A few states have altered their laws in response to the increasing prevalence of workplace shootings. For example, Colorado now allows claimants to receive workers’ compensation benefits based on PTSD in many situations in which the precipitating event was not extraordinary or unforeseeable.
Evidence in PTSD Claims
You should develop a claim based on PTSD very thoroughly, ideally with the assistance of an attorney. Insurers rarely approve these claims without a careful investigation. They may suspect that the claimant is exaggerating their symptoms, even with a legitimate diagnosis, or they may suspect that the symptoms were caused by trauma in their personal life. You will have a better chance of getting benefits if you can produce a record of consistent mental health treatment. The record should include not only the diagnosis of PTSD and a description of your symptoms but also the doctor’s opinion on how your symptoms affect your ability to work. You can introduce testimony from coworkers and friends who have seen how the PTSD has affected you.
PTSD or similar mental health conditions may be called "mental-mental" claims when they result from non-physical work conditions.
Seeking treatment once you start noticing your symptoms can be critical in developing adequate documentation for your claim. Doctors recognize that symptoms of PTSD may not develop for a long time after the precipitating event, but insurers still may be skeptical. This can make proving causation more challenging unless you have solid medical records. The insurer also may want to interview other witnesses of the incident to verify its severity and its impact on you.