Workers’ compensation is generally known for covering physical injuries in the California workplace. However, some people may not be aware that California law also provides for workers to sue for damages related to psychiatric injuries as well. While workers may not suffer explicit physical harm, traumatic events on the job may cause stress-related problems that can be compensated for.
According to the Findlaw website, California code 3208.3 establishes that a worker can be compensated for psychiatric injuries if a mental disorder is diagnosed that either causes a disability or a necessity of treatment. However, an employee should have been working at the job for no less than six months. Still, this time period does not have to be continuous. An individual could have been employed for a span of time, left the job, and then come back to complete at least six months of employment.
The law also sets some requirements that an injured worker must meet to have a legitimate claim. Basically, an employee should be able to prove that his or her mental problems were caused predominantly by the events that took place at work. According to the American Bar Association, claims of mental stress should also be supported by the testimony of a physician. Such reports are to be supported by a thorough review of the worker’s background. This review can include the worker’s job satisfaction, developmental history, reviews of the employee’s performance and any personal problems.
Finally, it should be noted that certain claims for psychiatric injuries are considered invalid by law. These may include claims for injuries caused by actions that are deemed lawful, are performed in good faith, and are nondiscriminatory. There are also some employment conditions that do not fall under the six-month time span, which can be described as extraordinary or abrupt.
Learn more about the legal process from our guide:
How to Process a Workers’ Compensation Claim
What Qualifies as a Psychiatric Injury Under California Workers’ Compensation Law?
Under California Labor Code Section 3208.3, a psychiatric injury must meet the following conditions:
- Be diagnosed using DSM-V criteria by a licensed physician or psychologist.
- Result in either a temporary or permanent psychiatric disability or require medical treatment.
- Be predominantly (at least 51%) caused by actual events of employment.
Common Diagnosed Conditions in Work-Related Psychiatric Claims:
- Post-Traumatic Stress Disorder (PTSD)
- Major Depressive Disorder (MDD)
- Anxiety Disorders
- Adjustment Disorders
- Occupational Burnout
- Panic Disorder
Learn more: Psychological Stress Injuries Lawyer Van Nuys
Filing a Psychiatric Workers’ Compensation Claim in California: Step-by-Step
- Report the incident to your employer immediately.
- Seek medical evaluation from a Qualified Medical Evaluator (QME) or Primary Treating Physician (PTP).
- Submit a DWC-1 Claim Form.
- Provide medical records and background information supporting your diagnosis.
- The employer’s insurance carrier will investigate the claim.
- Based on the findings, your claim will be accepted, denied, or delayed.
Due to the complexity, Delayed Claims are common in psychiatric cases.
Understanding Apportionment in Psychiatric Injury Claims
Apportionment refers to the division of responsibility between work-related causes and non-industrial factors (such as personal history or prior mental health issues).
A psychiatric injury claim may be partially compensable if the medical evaluator determines that:
- Only a portion of the injury was caused by the work environment.
- Other causes (e.g., family stress, previous trauma) contributed to the condition.
Medical reports must clearly explain the percentage of causation attributed to work.
Situations Where Psychiatric Claims May Be Denied
Even with a valid diagnosis, your claim might be denied if:
- The psychiatric condition was caused by a lawful, nondiscriminatory, good-faith personnel action, such as demotion, discipline, or termination.
- Employment lasted less than 6 months, and no extraordinary workplace event occurred.
- There’s no verifiable medical evidence or physician report linking the injury to work.
- The claim is based solely on personal dissatisfaction or interpersonal conflict without a documented traumatic event.
More info: Denied Claims Attorney in Van Nuys
What’s the Difference Between a QME and a Treating Physician?
In workers’ compensation, there are two types of medical evaluators:
- Treating Physician (PTP): Provides ongoing care and treatment.
- Qualified Medical Evaluator (QME): Appointed by the DWC Medical Unit to provide an independent medical-legal evaluation.
You may also see an Agreed Medical Evaluator (AME) if both parties select one evaluator together.
Read: Choosing a Doctor – 3 Things to Know
Important Timelines to Know
- 30 days: Employer must provide access to medical treatment after notice of injury.
- 1 year: Statute of limitations to file a workers’ compensation claim after injury.
- 20 days: Employer must respond to QME panel requests.
- 60 days: Time for QME to submit their report after evaluation.
Employer Responsibilities in Psychiatric Injury Cases
Employers are legally required to:
- Provide medical treatment within the mandated timeframes.
- Cooperate with QME and WCAB procedures.
- Not retaliate against workers for filing legitimate claims.
- Maintain confidential handling of psychiatric health data.
They may challenge a claim if they believe it was caused by non-industrial factors or lawful personnel actions.
Want to reduce legal risk? Information for Employers
Best Practices for Employers to Prevent Psychiatric Claims
To reduce psychiatric injuries in the workplace, employers can:
- Implement mental health awareness training.
- Offer Employee Assistance Programs (EAPs).
- Conduct regular wellness check-ins and stress management workshops.
- Encourage open communication and a respectful culture.
FAQs: Psychiatric Workers’ Compensation in California
Do I need to prove that work was the main cause of my psychiatric condition?
Yes. At least 51% of the injury must be attributed to job-related events.
Can a stressful work environment qualify me for workers’ comp?
It can. But it must lead to a diagnosed disorder (e.g., PTSD, anxiety), not just general stress.
What happens if my claim is denied?
You may file an appeal with the Workers’ Compensation Appeals Board (WCAB) and may request an Agreed Medical Evaluator (AME) or a second opinion from a QME.
Are psychiatric injuries treated differently from physical injuries in California?
Yes, psychiatric claims are subject to stricter rules and require more detailed medical-legal documentation.
Can I get partial compensation if the condition is only partly work-related?
Yes. This is handled through apportionment, which determines how much of the condition was caused by work versus other factors.
Speak to a Workers’ Comp Attorney About Your Psychiatric Injury
At Hussain & Gutierrez, we understand how complex and emotionally draining psychiatric workers’ compensation cases can be. If you’ve experienced a traumatic event or ongoing stress in your workplace, our team can help you secure the benefits you deserve.
Contact us now for a free consultation
Or call (888) 997-3701 to speak with an experienced workers’ compensation attorney today.
