7 IMPORTANT ISSUES TO CONSIDER BEFORE FILING A PSYCHIATRIC INJURY CLAIM

Claims for psychiatric injury are complicated claims. There are several issues to be aware of before you file this type of claim. As a Workers’ Compensation attorney that has represented first responders on hundreds of claims for psychiatric injury, here are some tips regarding what types of claims are compensable under current California law and some examples of claims that are not.

1. Please be aware that you are virtually waiving your right to privacy regarding your personal life if you file this type of claim. Your marital relationship, financial affairs, disciplinary history and your entire mental health history are now open for inspection. For example, many first responders have served in the military and have a PTSD award from the VA. Those records will be reviewed. That’s because a defense to this claim is for the claims adjuster to show that 51% or more of your claim of psychiatric injury is caused by events outside of work. That will defeat the claim. Thus, the defense will ask you at a deposition about these past issues that may have caused some level of psychiatric harm. The evaluating doctor could then determine that the PTSD from work is less than 51% of your injury, which would defeat the claim.

2. The requirement for a compensable psychiatric claim is that 51% of your psychiatric injury, as determined by an appropriately licensed health care professional, is caused by work events. This psychiatric evaluation will be a combination of testing and face to face evaluation. It will take several hours to complete.

3. Also, please don’t think you can file a psychiatric claim to avoid disciplinary action. If some portion of your psychiatric injury is caused by disciplinary action that amount is “subtracted” from your total claim and may drop you below the 51% requirement, defeating your claim. The legal term for this defense is the “good faith personnel defense.” This means that your employer was acting in “good faith” in the course of business.

4. If you have been diagnosed with PTSD and you have been working as a first responder for over 6 months, this type of claim is usually compensable in California. You can still claim PTSD within 6 months of employment but the injury must be “sudden and extraordinary.” That would likely mean shooting is involved or you have responded to a mass casualty event.

5. There is a relatively new legal presumption that PTSD is due to your employment as a first responder. This is found in Labor Code Section 3212.15. First responders often respond to traumatic events like auto accidents, suicides and domestic violence so developing PTSD over time is not uncommon.

6. Don’t file a claim for psychiatric injury because you don’t like the way your boss manages the department. You may not agree with how your boss manages your department and it may cause you stress but that is generally not a compensable claim in workers’ compensation. Further, don’t file a claim because nobody at work likes you. Your co-workers may not like you but that isn’t the problem of your employer. Finally, if you think that you are being targeted or retaliated against, you need to be careful. Everybody tends to think that they are being targeted but it can be very difficult to prove. Most workers’ compensation attorneys will not represent applicants where discrimination or harassment is being alleged.

7. Finally, be aware that many of these claims for first responders, if successful, result in a disability retirement. Thus, your career may end. Make sure you are ready for a possible disability retirement. Further, there are circumstances where retirement due to a psychiatric injury will preclude a peace officer from a concealed carry permit post-retirement.

Over the years, I’ve worked on several cases where the mental health struggles of first responders led to complex claims. One case involved an officer with over two decades of service who was facing disciplinary action for drinking on duty. Despite personal struggles, a closer look revealed actions were linked to PTSD caused by work-related experiences. With multiple traumatic incidents throughout one’s career, including high-profile events involving fatalities, this case was ultimately recognized as a valid psychiatric injury.

Another case involved an officer who had spent a decade in the child abuse unit. The emotional toll from investigating such disturbing cases eventually led to psychiatric harm, forcing the officer into early retirement. Similarly, I handled a case where an officer had been assigned to attend every autopsy in a particular county for years, a responsibility no one else had. The trauma from those assignments contributed to a psychiatric injury, making the claim compensable as well. These cases underscore how the unique and often harrowing responsibilities of first responders can lead to significant mental health challenges.

Below is the key language from Labor Code Section 3212.15. Please note that this section is set to expire on January 1, 2029. While it’s likely to be extended, we recommend checking back with our firm as 2029 approaches for updates. Additionally, this section applies even after a first responder has left service, providing coverage for up to 3 months for each year of service, with a maximum of 60 months after separation.

Labor Code 3212.15.  

(a) This section applies to all of the following:

(1) Active firefighting members, whether volunteers, partly paid, or fully paid, of all of the following fire departments:

(A) A fire department of a city, county, city and county, district, or other public or municipal corporation or political subdivision.

(B) A fire department of the University of California and the California State University.

(4) Peace officers, as defined in Section 830.1 of, subdivisions (a), (b), and (c) of Section 830.2 of, Section 830.32 of, subdivisions (a) and (b) of Section 830.37 of, Section 830.5 of, and Section 830.55 of, the Penal Code, who are primarily engaged in active law enforcement activities.

(5) (A) Fire and rescue services coordinators who work for the Office of Emergency Services.

(b) In the case of a person described in subdivision (a), the term “injury,” as used in this division, includes “post-traumatic stress disorder,” as diagnosed according to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association and that develops or manifests itself during a period in which any person described in subdivision (a) is in the service of the department, unit, office, or agency.

(c) For an injury that is diagnosed as specified in subdivision (b):

(1) The compensation that is awarded shall include full hospital, surgical, medical treatment, disability indemnity, and death benefits, as provided by this division.

(2) The injury so developing or manifesting itself in these cases shall be presumed to arise out of and in the course of the employment. This presumption is disputable and may be controverted by other evidence, but unless so controverted, the appeals board is bound to find in accordance with the presumption. This presumption shall be extended to a person described in subdivision (a) following termination of service for a period of 3 calendar months for each full year of the requisite service, but not to exceed 60 months in any circumstance, commencing with the last date actually worked in the specified capacity.

(d) Compensation shall not be paid pursuant to this section for a claim of injury unless the person has performed services for the department, unit, office, or agency for at least six months. The six months of employment need not be continuous. This subdivision does not apply if the injury is caused by a sudden and extraordinary employment condition.

(g) This section shall remain in effect only until January 1, 2029, and as of that date is repealed.

Because of the many difficulties involved in claims for psychiatric injury, and how prevalent PTSD can be for first responders, please make sure you are consulting with legal counsel. At Mastagni Holstedt, A.P.C. our attorneys are dedicated to helping clients navigate California’s complex Workers’ Compensation system.

Mastagni Holstedt, A.P.C. is the largest firm in California that represents injured workers and offers a free consultation to those seeking representation. If you have been injured at work and want to discuss your case and the possibility of representation, please call our office at (877) 212-6907 to set up a phone appointment with one of our experienced workers’ compensation attorneys.