Guide to Workers Comp Settlements for Post Traumatic Stress Disorder (PTSD)
You Can Get Benefits and a Settlement for PTSD and Other Psychological Injuries Caused by a Job-Related Event. Find Out How.
Workers compensation law provides medical coverage and wage loss replacement benefits for certain work-related injuries and occupational diseases. This includes both physical and psychological injuries and diseases.
One such psychological condition is PTSD, which stands for Post Traumatic Stress Disorder. Depending on how it develops, you may receive workers comp benefits for PTSD as an injury or an occupational disease, or as a compensable consequence of a physical injury.
State legislators, advocacy groups for workers, and mental health professionals have raised awareness of PTSD, reducing the stigma associated with mental illness. This has resulted in the expansion of benefits for those who suffer from PTSD because of a work-related incident or series of events.
The purpose of this article is to discuss how to increase the likelihood that you receive a fair workers compensation settlement for PTSD caused by your job. It discusses both the legal and medical issues that will determine the outcome of your PTSD claim.
If you have any questions after reading this article, or if you are looking for a top-rated work injury lawyer to help you increase the value of your workers comp settlement for PTSD, call me for a free consultation: (804) 251-1620 or (757) 810-5614. Come see why hundreds of employees have turned to me to get results in their workers comp case.
What is PTSD?
Post Traumatic Stress Disorder is a medical condition where you have difficulty recovering after experiencing or witnessing an event that caused psychological distress, fear, terror, or helplessness.
You may develop PTSD soon after the terrifying event. But it is not uncommon for there to be a gap between the event and your development of symptoms – sometimes months or even years. When there is a gap this is called Delayed PTSD.
What is the Difference Between Acute Stress Disorder and PTSD?
Some of you may be reading this article after receiving a diagnosis of Acute Stress Disorder caused by a workplace incident. And you may be wondering what the difference is between Acute Stress Disorder and PTSD for workers comp purposes.
Acute Stress Disorder is a severe reaction to a traumatic event within one month of the event itself. The main differences between Acute Stress Disorder and PTSD are that the symptoms of Acute Stress Disorder will begin and resolve within four weeks of the traumatic event.
Put another way: Acute Stress Disorder is PTSD for a period of less than one month.
How Is PTSD Diagnosed?
Usually, the assessment of Post Traumatic Stress Disorder involves a clinical interview with a mental health professional. The medical provider will likely conduct a structured interview then ask you to complete some self-report questionnaires.
The purpose of structured interviews for PTSD is to determine whether you have a specific group of symptoms. Commonly structured interviews include the Structured Clinical Interview for DSM (SCID), the Structured Interview for PTSD (SI-PTSD), the PTSD Interview, The Anxiety Disorders Interview Schedule-Revised (ADIS-R), the Clinician-Administered PTSD Scale (CAPS), and the PTSD Symptoms Scale Interview.
The purpose of self-report questionnaires to reach a diagnosis more efficiently and quickly so that treatment can begin. Common self-report questionnaires used to gather information about PTSD include the Post-Traumatic Diagnostic Scale; the Penn Inventory for Post-Traumatic Stress; the Impact of Event Scale-Revised, the Mississippi Scale for Combat-Related PTSD; and, the Keane PTSD Scale.
After interviewing you and evaluating your self-report questionnaires, your mental health provider determines whether you meet the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for Post Traumatic Stress Disorder.
Your mental health professional will diagnose PTSD if you satisfy each of these criteria:
Exposure to a Traumatic Event
The first criterion for the diagnosis of PTSD is exposure to a traumatic event.
A traumatic event is one that involves actual or threatened death, serious injury, or sexual violence.
Exposure is defined as directly experiencing the event, witnessing the event, learning that a close family member or friend experienced the event, or repeatedly being exposed to the details of the event.
Re-Experiencing the Traumatic Event
The second criterion for the diagnosis of PTSD is the persistent re-experiencing of the traumatic event.
You continue to re-experience the event if you have:
- Recurrent, involuntary, and intrusive distressing memories of the event;
- Recurrent distressing dreams related to the event;
- Flashbacks where you are awake and feel the event is happening again; or,
- A physical reaction or intense or long-lasting psychological distress when exposed to cues that symbolize an aspect of the event (a loud noise, red light, etc).
Avoidance of Anything that Reminds You of the Traumatic Event
The third criterion for a PTSD diagnosis is the avoidance of stimuli that remind you of the traumatic event. This includes avoiding thoughts, feelings, people, places, conversations, activities, situations, and objects that remind you of the trauma.
Change in Personality and Emotional Response
The fourth criterion for the diagnosis of PTSD is a change in your general responsiveness and emotions.
This includes having: an inability to remember parts of the traumatic event (dissociative amnesia); negative beliefs about your self (lowered self-esteem); you blame yourself for the traumatic event; feelings of guilt, fear, horror, anger, or shame frequently; lowered interest in doing things you once enjoyed; difficulty interacting with others; or, difficulty being happy or thinking positively.
Persistent Feelings of Arousal
The fifth criterion for a PTSD diagnosis is having persistent and recurrent feelings of arousal. This includes angry outbursts for no reason; irritability; impulse control (reckless behavior), hypervigilance (thinking someone is out to get you); problems with concentration; or, difficulty falling asleep or staying asleep.
Duration of Symptoms
To be diagnosed with PTSD you must experience the symptoms and feelings described for at least one month.
Severity of Symptoms
The final criterion for the diagnosis of PTSD is whether you experience a disturbance that causes significant impairment in performing activities of daily living (ADLs) or in your social or occupational functioning.
What are Common Causes of PTSD?
The primary cause of Post Traumatic Stress Disorder is a traumatic event that is outside the range of normal human experience. Examples of traumatic events that can cause psychological injury include:
- Amputations
- Burn Injuries
- Car Accidents, including Motor Vehicle Crashes on the Job
- Childhood Neglect
- Gunshot Wounds
- Imprisonment
- Motorcycle Accidents
- Natural Disasters (Earthquakes, Fires, Floods, Hurricanes, Tornadoes)
- Occupational Exposures to Horrifying Events (Nursing Home Deaths from COVID-19, Crime Scene Investigations, Shootings)
- Physical Assault, including Workplace Violence
- Robbery
- Sexual Abuse/Sexual Assault
- Sports Injuries
- Traumatic Brain Injury (TBI), including Concussions
- Truck Accidents
- Verbal Abuse
- War (Combat veterans have a high incidence of PTSD)
- Workplace Harassment
- Workplace Stress
How Common is PTSD?
PTSD is common, not only among those of you who were hurt on the job or exposed to a terrifying event at work but also among the general public. It is a natural reaction to an extreme event.
At least one study has found that close to 8% of Americans will have PTSD at some time in their life, with women more likely than men to develop Post Traumatic Stress Disorder.
How Long Does PTSD Last?
Some of you may feel better within a few months of developing symptoms of PTSD. While others may experience chronic Post Traumatic Stress Disorder, meaning your PTSD will last for years or even your lifetime.
Chronic PTSD puts you at greater risk of suffering major depression, anxiety disorder, panic disorder, behavior and conduct disorder, phobia, and substance abuse disorder. If you were exposed to a terrifying event and have been diagnosed with any of these conditions, ask your doctor to screen you for PTSD.
What Other Medical Problems Do People with PTSD Have?
If you suffer from work-related PTSD you are at higher risk of having another mental health problem such as depression, anxiety, alcohol, and substance or drug abuse.
It is also common to have problems interacting and socializing with other people or to experience fatigue, lethargy, or pain because of your PTSD and depression.
Under the Workers Compensation Act, you can receive cash and medical benefits for any of these other mental health problems caused by your work-related Post Traumatic Stress Disorder.
What Treatment Can I Get for PTSD?
Many people avoid or wait to get medical treatment for Post Traumatic Stress Disorder because they think doing so is a sign of weakness or they feel ashamed. Fortunately, increased awareness of PTSD is reducing that stigma and more people are getting the treatment they need.
There are a number of medical treatment approaches for PTSD. It is important that you consider the costs of each when trying to reach a settlement for Post Traumatic Stress Disorder.
Common treatment methods for PTSD and other psychological injuries include:
- Biofeedback: This method teaches you how to recognize sources of tension and fear, and how to adjust.
- Cognitive Behavioral Therapy (CBT). This treatment method teaches you how to change the way you react to feelings about the traumatic event.
- Medication: Some medications, including drugs used to treat anxiety and depression, have been found to help persons with PTSD. Usually, medical providers prescribe SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) for PTSD.
- Therapy: Both individual therapy and couples therapy has been found to help people suffering from PTSD. Types of therapy include cognitive therapy, exposure therapy, mindfulness therapy, and eye movement desensitization therapy.
Even if you do not settle your PTSD claim you may still receive this treatment at your employer or its workers compensation insurer’s expense.
Why Should I Get Treatment for PTSD?
There are two main reasons to receive medical care for PTSD.
First, PTSD usually doesn’t get better when left untreated. And it often gets worse. So even if you think you are coping fine now, there is a risk that your symptoms of PTSD will become unbearable in the future.
Second, many people experience a better quality of life after receiving treatment. It may take some experimentation with available PTSD treatment methods and your symptoms may not go away completely, but treatment can improve your symptoms and help you regain some of the qualify of life you had before the workplace trauma.
Can I Recover from PTSD Completely?
Yes, it is possible to recover from PTSD completely,, especially if you seek medical treatment quickly. Treatment delays are associated with poorer prognosis.
When Can I Get Workers Comp for PTSD?
There are several ways to prove your claim for workers comp benefits for psychological injuries such as Post Traumatic Stress Disorder.
PTSD as a result of a Physical Injury (Physical-Mental)
The Workers Compensation Commission will award benefits if you develop PTSD after suffering a physical injury in a work-related accident.
For example, I have represented many employees who were diagnosed with PTSD after suffering a back injury, a herniated disc requiring spinal fusion, or a rotator cuff tear that limited their ability to return to their pre-injury job.
In my experience, these PTSD claims are the easiest ones to prove because your burden of proof is lower in these situations.
PTSD Resulting from a Sudden Shock or Fright on the Job
If you are seeking compensation for PTSD that developed after a specific event and is unaccompanied by a physical injury, you must prove that your PTSD resulted from a “sudden shock or fright” that was not expected in the performance of your employment duties.
There is no bright-line test for what is and is not considered a “sudden shock or fright.” The Workers Compensation Commission, however, has provided some guidance:
The types of precipitating events that give rise to purely psychological compensable injuries are consistently described as shocking, frightening, traumatic, catastrophic, and unexpected.
The issue is whether the event that precipitated the sudden shock or fright was something out of the ordinary in terms of the injured employee’s work duties, and was so dramatic or frightening as to shock the conscience.
To put yourself in the best position to win your claim or negotiate a fair PTSD workers comp settlement, I recommend presenting evidence on how the event that caused your PTSD differed from your other experiences at work and asking your doctor to write a report explaining why this specific event caused a sudden shock or fright. Do not rely on your testimony alone.
PTSD Developing Over Time Because of Multiple Traumatic Experiences at Work: The Occupational Disease Theory
If you are seeking compensation for PTSD that developed over time you do not have to prove that a sudden shock or fright caused your psychological injury. Rather, you must prove that it was caused by traumatic experiences over time.
The Workers Compensation Act provides benefits for PTSD as an occupational disease. To receive these benefits you must present evidence showing:
- A direct causal connection between the conditions of your employment and your PTSD;
- That your PTSD followed as a natural incident of your employment, meaning you can present evidence of exposures to traumatic events;
- That your employment was the primary cause of PTSD; and,
- That non-work-related exposures are not the primary cause of your PTSD.
If you seek benefits for PTSD as an occupational disease, the employer and its workers compensation insurance carrier or third-party claim administrator (TPA) will likely argue that your psychological condition is an ordinary disease of life, not an occupational disease. You can still receive benefits for PTSD as an ordinary disease of life but your burden of proof is higher.
Special Rules for Workers Comp for PTSD Incurred by Police Officers and Firefighters
The empirical evidence proves police officers, firefighters, and first responders have an increased risk of developing PTSD. Depending on the exact study, it is estimated that close to 33 percent of first responders, including 20 percent of police officers and 20 percent of firefighters, have suffered from PTSD. This is many times the national average for the general population.
This makes sense. EMTs, law-enforcement officers, and firefighters are exposed to traumatic, violent, and awful events.
Recognizing the association between law-enforcement and firefighters and Post Traumatic Stress Disorder, the General Assembly passed a new law recently that will make it easier for police officers and firefighters to recover workers comp benefits for PTSD in Virginia. This statute is similar to the Heart and Lung Bill for Police, Firefighters, and First Responders, though its occupational disease presumption is not as strong.
This new law, titled Post-Traumatic Stress Disorder Incurred by Law-Enforcement Officers and Firefighters, is effective beginning July 1, 2020. Found at Virginia Code Section 65.2-107, the law states that those of you who are police officers or firefighters may receive workers compensation if:
- A mental health professional examines you and diagnoses you as suffering from PTSD as a result of your exposure to a qualifying event. A qualifying event is defined as any incident or exposure: (1) resulting in serious bodily injury or death to any person or persons; (2) involving a minor who has been injured, killed, abused, or exploited; (3) involving an immediate threat to your life or another person’s life; (4) involving mass casualties; or (5) responding to crime scenes for investigation.
- Your PTSD resulted from you acting in the line of duty and, if you are a firefighter, developed even though you complied with federal Occupational Safety and Health Act (OSHA) standards.
- The qualifying event was a substantial factor in causing your PTSD. This means the qualifying event must be the primary cause of your PTSD.
- Your PTSD did not result from any termination, layoff, disciplinary action, work performance evaluation, job transfer, demotion, or retirement.
Though this law will help those of you who are police officers and firefighters get workers compensation for PTSD, it does place limits on how long you can receive income replacement benefits such as temporary total disability (TTD) and temporary partial disability (TPD) payments. It also places limits on the amount of workers comp benefits you can receive if you are also receiving other benefits such as Social Security Disability, Long Term Disability, Short Term Disability, and Virginia Retirement System (VRS) Work-Related Disability.
The law also requires employers of police officers or firefighters to provide peer support a referral to a mental health professional to any police officer or firefighter that asks for mental care services.
Further, municipal fire departments must include resilience and self-care technique training to all firefighters who begin basic training on or after July 1, 2021.
Virginia is one of many states across the nation that is taking steps to make it easier to receive workers comp for PTSD and other mental health conditions. I hope this trend continues.
What is the Average Workers Comp Settlement Amount for PTSD?
PTSD claims are often disputed and contested by employers and insurers. But if you prepare your claim properly and put yourself in a good position to win on compensability, or actually win on compensability at a hearing, it is possible to receive a large settlement.
In my experience the average workers comp PTSD settlement is between $50,000.00 and $95,000.00 if you did not suffer a physical injury. If you suffered a physical injury that resulted in Post Traumatic Stress Disorder, then it is possible to receive much more, depending on the severity of your physical injuries.
I have negotiated many six-figure PTSD settlements, including one for more than $650,000.00.
What to Consider When Trying to Negotiate a Workers Compensation PTSD Settlement: Focus on Your Inability to Return to the Same Work Environment and Your Potential Wage Loss
There are many factors to consider when determining a fair workers comp settlement amount for Post Traumatic Stress Disorder.
But I think the most important question you have to answer before settling your PTSD claim is: Will I be able to return to my pre-injury job after a diagnosis of PTSD? That is because much of the settlement value of a PTSD claim consists of your potential future wage loss, not your medical treatment.
Compared to workers comp claims based on a serious physical injury, where one or more surgeries and lifelong pain management may be necessary, PTSD claims do not have the same amount of medical costs. Your employer and its insurer, therefore, are likely more concerned about their financial exposure for indemnity benefits and less concerned about the medical costs associated with your PTSD claim. And you should focus on this factor when trying to negotiate a fair PTSD settlement amount.
Many of my clients, even those who have had a great recovery and who feel like they have returned to their baseline level of functioning with just a few flares, are told by their medical doctors, psychologists, and counselors to change careers. Placing yourself in the same situation that resulted in PTSD or around people, places, and things that may remind you of the traumatic event puts you at increased risk of suffering psychiatric symptoms for a long time.
This doesn’t mean you should ignore the medical costs associated with treating PTSD and common comorbidities such as depression, anxiety, and suicidal ideation. It simply means you cannot rely on the medical component of your PTSD claim alone to persuade your employer and its workers compensation insurance carrier to offer a fair amount.
Need Help Getting Workers Comp for PTSD? Call Me Today.
Workers comp claims based on PTSD are some of the most difficult to win. But it is possible.
From start to finish I’m here to help you navigate the workers comp claims process. By working with your mental health professionals, including psychiatrists, psychologists, counselors, social workers, and therapists, and conducting using the workers comp discovery process, including interrogatories, depositions, and requests for the production of documents, I can put you in the best position possible to recover workers comp and Social Security Disability benefits for PTSD related to your job.
Call now to get started: (804) 251-1620 or (757) 810-5614. The workers compensation statute of limitations for PTSD is two years from the date of the traumatic event if you experience sudden shock and fright and two years from the date you are diagnosed with PTSD if you are claiming it as an occupational disease.
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