One of the least-discussed elements of our health during the COVID-19 pandemic concerns our mental and psychological well-being. However, as many health experts will tell you, the intersection between these two areas of our well-being is a very busy place to be. In many respects, it is difficult to have physical health without a strong component of mental well-being and vice versa.
The Pennsylvania Workers’ Compensation Act also recognizes the intersection of mental and physical health, as well, given that psychological injuries are recognized as compensable. There are three different types of workers’ compensation psychological claims in Pennsylvania:
- The Physical/Mental Claim
- The Mental/Physical Claim; and
- The Mental/Mental Claim
While there are some black-letter legal principles associated with these types of claims, they are also very fact-intensive, in that the facts and circumstances surrounding these cases play heavily in the final legal outcome. In many instances, a small fact here or there can change the entire outcome as to whether or not such a claim is even compensable under the Act.
In assessing these three types of psychological claims, the injured worker, aka the Claimant, bears the legal burden of proof to establish that the claim is compensable. The burden of proof that the Claimant must meet is to show:
- An employment relationship
- That there was an injury;
- Which occurred in the course and scope of employment; and
- Which was “related thereto”
These elements can be very challenging to prove for a psychological claim for two reasons. First, as noted above, the facts and circumstances can vary significantly, and even small variations can and do produce different outcomes. And second, the “related thereto” component requires competent medical expert testimony, which can and does take a number of different twists and turns.
When it comes to a “Physical/Mental” claim, what that means is that the physical stimulus or injury caused a compensable mental injury. An example of this type of claim is outlined in a well-known case. In New Enterprise Stone and Lime Co. v. WCAB (Kalmanowicz), 59 A.3d 670 (Pa.Cmwlth. 2012), the injured worker was involved in a motor vehicle accident that was caused by a suicidal driver. In addition to the physical injuries that resulted from the accident, the Claimant later suffered from post-traumatic stress disorder. The Court found the PTSD to be compensable, stating that an “abnormal working condition” was not necessary to prove the case because the accident was a “triggering physical event.”
An element of a physical/mental claim that must also be proven is that the physical injury must be more than a “mere touching,” or “slight bruising.” This means that there must be some measure of injury necessitating medical treatment for the “physical component” to be satisfied.
Another example of this type of claim was seen in a case where I recently represented the injured worker. In that case, my client, a PennDOT driver’s license examiner, was punched in the face/head by an irate customer (who was asking my client to do something illegal in order to take the driving test). My client suffered a concussion, missed a short time from work, but also had a measure of resulting mental health trauma from the incident. My client’s physical injury was sufficient because it caused the need for medical treatment, and in turn the insurance carrier was responsible for paying my client’s medical treatment, as well.
A Mental/Physical case is similar to the above, in that it does not require proof of an “abnormal working condition.” The Courts in Pennsylvania recognize that psychological stress that results in “purely” physical injuries is compensable. A classic example of this type of injury is the stress-related heart attack, which has come up in the case law often. However, the Courts have also recognized that the stress brought on by a termination of employment is not compensable, as the employment relationship has already ended by the time that the physical injury occurs.
The ”heart attack” claim also highlights the challenge of presenting medical evidence in these types of claims. Often, if not most of the time, these types of claims and cases involve workers who have significant underlying cardiovascular disease. As such, there is often a significant debate among the medical experts in a case like this about whether or not the work stress actually caused the physical injury. Therefore, it is absolutely critical in a case like this to have an experienced medical expert in the injured worker’s corner.
Finally, perhaps the most complicated of all of the psychological claims in Pennsylvania workers’ compensation is the “Mental/Mental” claim. This is the type of claim that involves a mental stimulus (without any physical injury) causing a mental injury. This involves the “added” requirement for the injured worker to prove an abnormal working condition as a prerequisite to benefits. The “abnormal working condition” requirement is best explained by reference to an example. The Courts recently addressed a liquor store manager being robbed at gunpoint, concluding that this was indeed “abnormal” in consideration of the facts and circumstances, and in particular the geographic area in which this occurred and the expectations for the employee upon accepting the position.
By contrast, it is much more difficult for fire/EMS/police personnel to prove an abnormal working condition as part of the claim for a mental/psychological injury. Reason being, the Courts have noted that when an individual applies for and accepts this type of a position, he/she is aware of the risks/exposures and likely scenarios that will be confronted in the day-to-day job duties. As such, Courts are more prone to find that this threshold requirement of an abnormal working condition did not exist. This type of case highlights once again the Courts’ reliance on the facts and circumstances on a case-by-case basis in making a determination as to compensability.
Putting all of these factors together, it is easy to see why psychological claims and injuries often prove challenging for parties and Courts alike. By the same token, as we enter similarly uncertain times in 2021, it is also important to recognize just how the Pennsylvania Workers’ Compensation Act accounts for the compensability of psychological injuries.
Eric J. Stark, Esq.
Eric Stark is a graduate of Elizabethtown College and Widener University School of Law. He has been practicing in the areas of workers’ compensation and employment law in Central Pennsylvania since 2005. He has represented employers and individuals in these claims and recently launched Stark Law Group, LLC in Lancaster.