Psychiatric Conditions in Workers’ Compensation Cases

Most work injuries are physical in nature. Whether you suffer broken bones from a fall or injure your back while lifting, there is some damage to your body for most people who experience a workers’ compensation injury in Florida.  Those who have physical injury on the job should generally be able to receive workers’ comp benefits. However, there are certain serious work injuries that are much more difficult to pursue benefits for through the Florida workers’ compensation system. These injuries are psychiatric in nature. This blog article will discuss the applicable statute and some case law explaining how psychiatric conditions are handled in workers’ compensation cases.

The statute and case law applicable to injuries occurring on or after 10/1/03.

1. The statute

• 440.093 Mental and nervous injuries.—
  (1) A mental or nervous injury due to stress, fright, or excitement only is not an injury by accident arising out of the employment. Nothing in this section shall be construed to allow for the payment of benefits under this chapter for mental or nervous injuries without an accompanying physical injury requiring medical treatment. A physical injury resulting from mental or nervous injuries unaccompanied by physical trauma requiring medical treatment shall not be compensable under this chapter.
  (2) Mental or nervous injuries occurring as a manifestation of an injury compensable under this chapter shall be demonstrated by clear and convincing medical evidence by a licensed psychiatrist meeting criteria established in the most recent edition of the diagnostic and statistical manual of mental disorders published by the American Psychiatric Association. The compensable physical injury must be and remain the major contributing cause of the mental or nervous condition and the compensable physical injury as determined by reasonable medical certainty must be at least 50 percent responsible for the mental or nervous condition as compared to all other contributing causes combined. Compensation is not payable for the mental, psychological, or emotional injury arising out of depression from being out of work or losing employment opportunities, resulting from a preexisting mental, psychological, or emotional condition or due to pain or other subjective complaints that cannot be substantiated by objective, relevant medical findings.
  (3) Subject to the payment of permanent benefits under s. 440.15, in no event shall temporary benefits for a compensable mental or nervous injury be paid for more than 6 months after the date of maximum medical improvement for the injured employee’s physical injury or injuries, which shall be included in the period of 104 weeks as provided in s. 440.15(2) and (4). Mental or nervous injuries are compensable only in accordance with the terms of this section.

• 440.15 (3) (c)

“Impairment income benefits as defined by this subsection are payable only for impairment ratings for physical impairments. If objective medical findings can substantiate a permanent psychiatric impairment resulting from the accident, permanent impairment benefits are limited for the permanent psychiatric impairment to 1% permanent impairment.”

440. Case law under 440.093

1. McKenzie v. Mental Health Care, Inc., 43 So.3d 767 (Fla. 1^st DCA 767)

1. Generally

In the author’s opinion, this case, more than any other case, provided a thorough and comprehensive explanation of section 440.093, and should be viewed as the starting point for any current analysis of entitlement to psychiatric benefits under the 2003 legislative changes.

1. Facts

The claimant, a registered nurse, worked in a treatment center that houses patients with behavioral and mental disorders. While at work, a violent patient attacked her and struck her in the neck and throat. As a result of the accident, she was diagnosed with a laryngeal contusion and vocal cord hematoma. These physical injuries required medical treatment. The employer/carrier accepted these claims as compensable. In addition to the claims based on her physical injuries, the claimant claimed psychiatric injuries and requested treatment with a psychiatrist. The employer carrier denied the psychological claims, alleging the psychiatric injuries were not compensable. At a hearing before the JCC, both parties arguments focused on section 440.093 (2), which authorizes coverage for psychiatric injuries that manifest themselves as a result of a physical injury otherwise compensable under chapter 440. In light of both parties’ arguments, the JCC denied the compensability of the psychiatric injuries, concluding there was no evidence that the claimant’s laryngeal contusion and vocal cord hematoma alone constituted at least 50% of the hurt of the cause of her PTSD, dysthymic disorder, anxiety disorder, or personality disorder.

440. The court’s analysis of the various components of 440.093

“…Section 440.093 (1) contains three sentences, with each sentence addressing different situations when mental or nervous injuries may arise in the workplace. Section 440.093 (2) defined the fourth situation involving mental or nervous injuries.

The first sentence in 440.093 (1) provides ‘a mental or nervous injury due to stress, fright, or excitement only is not an injury by accident arising out of the employment.’.. This provision precludes coverage for mental or nervous injuries caused only by mental trauma…. Examples might include a situation where an employee experiences mental trauma after being robbed at gunpoint, but does not suffer a physical injury requiring medical treatment; or perhaps a situation where an employee suffers a mental or nervous injury as a consequence of witnessing some horrific event at the workplace…

The second sentence in section 440.093(1) provides: ‘nothing in this section shall be construed to allow for the payment of benefits under this chapter for mental or nervous injuries without an accompanying physical injury requiring medical treatment.” This second provision recognizes and makes compensable mental or nervous injuries that accompany a separate physical injury serious enough to require medical treatment. Critically important to the interpretation of this provision is the recognition that a workplace accident can cause an employee to suffer both a physical and a separate mental or nervous injury…. Generally, if a separate mental or nervous injury occurs at the same time as a physical injury requiring medical treatment, the mental or nervous injury will also be compensable. For example, if an employee, in the course and scope of employment, is sexually assaulted at the workplace and suffers a physical injury that requires medical treatment, the physical injuries are certainly compensable. If the employee also suffers a mental or nervous injuries, separate and apart from the physical injury, the mental or nervous injury is compensable because it would meet the section 440.09 requirements and also comply with section 440.093 (1). In this hypothetical situation, the employee would have simultaneously suffered two compensable workplace injuries: one physical and one mental… 

The third sentence in section 440.093(1) provides: ‘ physical injury resulting from mental or nervous injuries, unaccompanied by physical trauma requiring medical treatment shall not be compensable under this chapter. This third provision precludes coverage when a mental or nervous injury, not accompanied by physical injury requiring medical treatment, causes a subsequent physical injury. Thus, an employee under this provision will not receive compensation for a physical injury If that physical injury occurred solely as a result of the employee experiencing mental or nervous trauma at the workplace. An example of the situation may be where an employee becomes stressed or nervous about something occurring at work and the stress or nervous. This causes the employer to suffer a heart attack or other internal failure. In this hypothetical, the physical injury (the heart attack) him was caused by the mental or nervous injury (stress, fright, excitement) they would not be compensable under chapter 440.”

Subsection 440.093(2) defines a fourth situation involving mental or nervous injury. This subsection authorizes coverage for mental or nervous injuries which are the manifestation of the physical injury otherwise compensable under Chapter 440. Under the workers’ compensation law,” manifestation” is a disease or infection that naturally or unavoidably results from an initial, compensable workplace injury… Pursuant to this provision, an employee who suffers an initial physical injury requiring medical treatment may recover for any mental or nervous injury that manifests, so long as the initial physical injury is the major contributing cause of the mental or nervous injury… For example, if an employee loses a limb operating heavy machinery and, over time, the loss of the limb causes the employee to become clinically depressed or mentally unstable (a natural manifestation of the physical injury), the mental or nervous injury will also be compensable under chapter 440. Another example may arise in a situation where an employee suffers a physical injury that causes long-term chronic pain. If the chronic pain eventually results in the employee suffering a mental or nervous injury requiring treatment, the mental or nervous injury would be compensable as the manifestation of the physical injury.

1. Conclusion

The claimant had argued that the JCC erred in finding her mental injuries were not covered under section 440.093(2). However, at the hearing before the JCC, the claimant did not present any evidence to support her claim that a compensable mental or nervous injury have manifested as a result of for physical injuries. Instead, the record indicated she presented evidence that she may have suffered a separate mental or nervous injury that accompanied (occurred at the same time as) the physical injuries to her neck and throat. In fact, two different psychiatrists testified that the claimant’s mental or nervous injuries were the result of the accident (the attack at her workplace), not the result of the physical injury to the claimant’s neck. The court concluded that because these mental or nervous injuries may have occurred at the same time as the physical injuries that required medical treatment, the medical mental or nervous injuries could only be compensable under the second sentence in section 440.093(1). Therefore, the JCC was correct in finding they could not, without further evidence, be compensable under section 440.093 (2). Because the claimant had presented evidence relating directly to the type of mental or nervous injury defined in the second provision of section 440.093(1), but made an argument based on the type of injury defined in section 440.093 (2), the court concluded the JCC was correct in finding there was insufficient evidence to support the claimant’s argument that she was entitled to compensation pursuant to 440.093 (2). However, because the court concluded that both the claimant in the employer carrier were uncertain as to the nuances of section 440.093, the matter was reversed and remanded for further proceedings, including the taking of additional evidence, if necessary.

2. Cases following McKenzie

• Alachua County Fire Rescue v. Hoskinson, 93 So.3d; 1014 (Fla.1^st DCA 2012); PCA issued. This case addressed the issue of the compensability of a psychiatric condition that was alleged to have been the manifestation of a physical injury otherwise compensable under Chapter 440. The court noted that “… to establish entitlement to coverage under section 440.093 (2), claimant must prove by clear and convincing medical evidence by a licensed psychiatrist that his psychiatric condition was a manifestation of the chronic pain that resulted from the physical injuries he sustained in his work accident, and that the work accidents are the major contributing cause of the manifestation and need for treatment..”

• McIntosh v. CVS Pharmacy,  ____ So.3d____, opinion filed 4/22/14:

1. Facts

The claimant, a pharmacist, was at work on 10/19/10 when an armed robber entered the store. Claimant was six months pregnant at the time the gunman ordered claimant to get down on the floor. Claimant attempted to flee, and in so doing, fell, landing on her stomach. The JCC found the claimant sustained a compensable physical injury to her right knee, albeit a minor one, at the time of the accident for which claimant received treatment at an emergency room on the date of the accident. The JCC also found the claimant was subsequently diagnosed with PTSD by a psychiatrist authorized by the carrier. The JCC found the doctor had causally related the PTSD to the events occurring on the date of the accident, not to any physical injury suffered on that date.

Conclusion

The court concluded that section 440.093(2) is not applicable because the relevant mental or nervous injury did not occur as a manifestation of an injury compensable under this chapter. The court concluded that the situation in the instant case most closely paralleled the second sentence in section 440.093 (1), (since the evidence suggested a separate mental or nervous injury occurred at the same time as the physical injury requiring medical treatment).  Consequently, the DCA concluded that the JCC erred in denying compensability of the claimant’s PTSD based on the finding that no competent, substantial evidence establish that the PTSD was the natural are unavoidable result of claimant’s minor physical injuries treated at the emergency room on October 19, 2010.

The Tampa work injury lawyers at Christopher J. Smith, P.A. have extensive experience with workers’ compensation claims. Call today to schedule your free case evaluation if you need help or guidance with your workers’ compensation claim. 

-This excerpt was taken from the written materials prepared by Christopher J. Smith for his presentation at the Workers’ Compensation Forum scheduled next week on this topic.