Psychological Workplace Injuries May Not Be Compensable

Comp claim citing psych issues resulting from alleged stalker disallowed

August 05, 2024 Photo

Job stress is an unfortunate reality of being part of today’s workforce. The capacity for being able to deal with such stress varies from worker to worker, but whether that stress is the cause of someone’s psychological "injury" is a question for medical professionals to determine. Often, however, such questions extend beyond the examination room and into the courtroom or before a workers’ compensation board.

Background

An employee at a convenience store alleged he developed psychological illness due to being “stalked” by a regular customer, claiming interactions with the patron went beyond the typical daily exchanges one might experience while working in a retail setting.

An independent medical examination (IME) affirmed there was a causal relationship. However, the claimant failed to disclose (and actively denied during IME intake) his prior psychological/psychiatric issues, including alcoholism, drug abuse, and psychotic illness, which warranted psychiatric care and prescriptions.

The carrier maintained there was no compensable work injury because the alleged “stalking” that caused the claimant’s psychological illness was not a case of stalking at all, but rather a series of friendly gestures that a regular customer often extends to workers. The carrier also maintained that if there was work-related stress, such stress was expected in the normal course of working in a retail position.

The Trial

At trial, the claimant compared the customer to a known serial killer and even linked him to missing-persons cases in the neighborhood. The claimant also went on to say he believed the customer was a “seasoned sociopath” who enjoyed stalking victims.

However, when asked what specific behaviors by the customer led him to believe he was being stalked, the claimant could not provide specific answers and merely stated the customer was “creepy.” Also, at one point, the claimant admitted he was testifying under the influence of marijuana purchased from unauthorized sources.

Based on foregoing admissions, the claim was entirely disallowed.

For workers’ compensation defense attorneys, the above case provides an outline one might want to consider when crafting a defense for a client facing similar claims. For instance:

  • Argue that such stressful events/environments are expected in the normal course of work for that type of employment.
  • Attacking a claimant’s credibility is particularly effective in psych cases, as the mechanism of injury would solely be based on claimant’s characterization of what specific event/environment allegedly caused their psychological issues. If a claimant is not credible, neither are the IME nor treating physician’s opinions affirming causal relationships because their opinions on causal relationships are based solely on claimant’s complaints.
  • Claimants with alleged psychological issues may also be susceptible to substance abuse or could be under the influence of prescribed drugs. If a claimant were under the influence of any such drugs/substances during their trial testimony, it could serve as a ground to discredit their testimony.
  • Should an adjuster conduct an initial investigative interview, open-ended questions allowing a claimant to freely discuss a claim may be effective since an uninterrupted narrative could include self-damaging admissions or inconsistencies, especially in psych cases.

Using such defenses could strengthen the argument that a claimant has overreacted to the normal level of stress expected for their job, possibly resulting in a workers’ compensation board deeming that an alleged psychological stress injury is not compensable per workers’ compensation statutes.

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About The Authors
Kyung Jae Han

Kyung Jae Han is an associate at Goldberg Segalla.  kjaehan@goldbergsegalla.com

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