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The Growing Recognition of Mental Health in Workers’ Compensation

Wed, 02 Oct 2024 18:26:07 GMT

Traditionally, workers' compensation claims were focused on physical injuries, such as slips, falls, or repetitive strain injuries. However, the modern workforce faces new pressures, with many employees struggling under the weight of chronic stress, workplace harassment, or even traumatic events experienced on the job. This has led to a broader acceptance of mental health conditions as legitimate workplace injuries.

Types of Mental Health Claims

Mental health claims typically fall into two categories:

Physical-Mental Claims: These occur when a physical injury leads to a mental health condition. For example, an employee who suffers a serious injury may develop anxiety, depression, or PTSD as a result of the trauma or long-term disability.
Mental-Mental Claims: These claims involve a mental health condition caused solely by emotional or psychological stressors without any accompanying physical injury. For instance, an employee may develop anxiety due to a toxic work environment or suffer PTSD after witnessing a traumatic event at work.

While many states recognize physical-mental claims, mental-mental claims are more difficult to pursue and are often subject to stricter requirements. Some states have stringent laws, while others offer little to no recognition for claims based on stress or anxiety alone.

Challenges of Proving Mental Health Claims in Workers’ Compensation

Despite the growing recognition of mental health injuries in workers' compensation, proving a mental health claim is still challenging. Unlike physical injuries, mental health issues are not always visible or easily quantifiable. Here are a few of the key obstacles employees face:

1. Burden of Proof

When filing a mental health claim, the burden of proof often falls on the employee. You must demonstrate that your psychological condition was directly caused by your work environment or job duties. This can be difficult, as many stressors can affect mental health outside of the workplace, such as personal issues or pre-existing conditions.

2. Documenting the Mental Health Condition

Medical evidence is critical in mental health claims, but it can be harder to gather than for physical injuries. Employees will need to provide documentation from mental health professionals, including diagnoses, treatment plans, and how the condition is related to work. Mental health evaluations can vary, and the subjective nature of stress and anxiety means different doctors may have different opinions on the severity or cause of the condition.

3. Stress vs. Ordinary Job Pressure

Workers’ compensation generally doesn’t cover stress that comes from the "ordinary pressures" of a job, like tight deadlines or disagreements with co-workers. To successfully file a claim, an employee must show that their stress or anxiety is abnormal or excessive when compared to what others in a similar role might experience. Claims involving harassment, bullying, or unsafe working conditions are more likely to be considered, especially if the employer failed to address these issues.

4. State Laws Vary

Workers' compensation laws vary widely by state, and mental health claims are no exception. Some states are more progressive in recognizing mental health injuries, while others maintain strict limits or outright deny claims for emotional distress without a physical injury. It’s crucial to understand your state’s laws and consult an attorney if you’re considering filing a mental health claim.

Steps for Filing a Workers' Compensation Claim for Mental Health

If you believe your mental health condition is work-related and you want to file a workers’ compensation claim, it’s important to be prepared. Here are the steps you should follow:

Report Your Condition Early: Just as you would report a physical injury, inform your employer of your mental health condition as soon as possible. The longer you wait, the harder it may be to prove the connection to your job.
Seek Medical Help: Visit a licensed mental health professional to receive an official diagnosis and begin treatment. Keep detailed records of all visits, diagnoses, treatments, and prescriptions, as these will be critical when filing your claim.
Document Work Conditions: Collect evidence of the work-related stress or trauma that led to your condition. This could include emails, reports of harassment, or witnesses to a traumatic event.
File Your Claim Promptly: Workers’ compensation claims have deadlines, so make sure to file your claim as soon as you’re aware of your condition and its connection to your job. Missing the deadline could mean losing your right to benefits.
Consult with a Workers' Compensation Attorney: Given the complexity of mental health claims, it’s often a good idea to work with an attorney who specializes in workers’ compensation. They can help you navigate the legal process, gather the necessary evidence, and advocate for your rights.

The Road Ahead: A Changing Attitude Toward Mental Health

As mental health continues to be a prominent issue in workplaces, the landscape of workers' compensation is slowly evolving. Some states are beginning to adopt more inclusive policies that recognize mental health claims, particularly in high-stress professions like first responders, healthcare workers, and educators. The stigma around mental health is also decreasing, allowing more employees to come forward with legitimate claims for stress, anxiety, and other psychological conditions.

However, significant challenges remain. Proving mental health claims will likely continue to be more difficult than physical injury claims, and employees must be diligent in documenting their conditions and gathering evidence.

Ultimately, with the right support and awareness, filing a workers' compensation claim for mental health is possible—and necessary—to protect the well-being of workers everywhere.

Conclusion: Mental Health is Just as Important as Physical Health

Mental health is an essential aspect of overall well-being, and it's encouraging to see workers’ compensation laws slowly acknowledging that fact. If you’re struggling with stress or anxiety due to your job, don’t hesitate to seek help and explore your options for filing a claim. With the proper support, you can receive the care and compensation you deserve while raising awareness for the importance of mental health in the workplace.

Interesting Facts About Workers' Compensation in New Mexico

Fri, 17 May 2024 21:57:12 GMT

No Fault System : New Mexico operates a no-fault system for workers' compensation. This means that employees can receive benefits regardless of who was at fault for their injury or illness, as long as it occurred during the course of employment.
Coverage Requirements: Almost all employers in New Mexico are required to carry workers' compensation insurance if they have three or more employees. This includes part-time and seasonal workers.
Construction Industry Exception : In the construction industry, all employers, regardless of the number of employees, must provide workers' compensation coverage.
Agricultural Workers: Interestingly, agricultural workers in New Mexico are exempt from mandatory coverage under the state’s workers' compensation laws, although employers can choose to provide coverage voluntarily.
Alternative Dispute Resolution : New Mexico has a unique system in place to resolve disputes related to workers' compensation. The Workers' Compensation Administration provides mediation services to help resolve issues before they require formal litigation.
Ombudsman Program : The state offers an Ombudsman Program to assist workers and employers in understanding their rights and responsibilities under workers' compensation laws. This program provides free guidance and can help with the filing of claims.
Uninsured Employers' Fund : New Mexico maintains an Uninsured Employers' Fund, which is designed to provide benefits to employees who are injured while working for an employer who illegally fails to carry workers' compensation insurance.
Safety Violation Penalties: If an injury is caused by the employer’s willful failure to comply with any statutory regulation or safety provision, the benefits payable to the injured worker may be increased by 10%.
Maximum Medical Improvement : After an injured worker reaches what is termed "maximum medical improvement" (MMI), if they are still not able to return to work, they may be eligible for permanent disability benefits depending on the degree of impairment.
Workers' Compensation Judges: New Mexico has specialized judges dedicated solely to workers' compensation cases, which helps streamline the process and provide expertise in the adjudication of these claims.

These aspects highlight the structured approach New Mexico takes towards protecting workers while also accommodating the needs and responsibilities of employers.

What to do if you get injured at work?

Tue, 20 Feb 2024 23:02:36 GMT

If you are in a workplace accident or get injured on the job, the State of New Mexico Workers’ Compensation Act and Administration has certain requirements with which you must comply before you are eligible to receive Workers’ Compensation benefits, including both medical and indemnity benefits. But there are requirements that your employer must comply with, as well.

Notice of Accident or Injury: Your employer is required to display the following WCA poster in a conspicuous place, such as a break room. If your employer fails to post the WCA poster, then an Injured Worker has up to 60 days to give notice of their work injury or illness. Your employer cannot refuse to accept a Notice of Accident form. Similarly, it is unlawful for an employer to retaliate against an Injured Worker for filing a Workers’ Compensation claim.

The WCA poster should indicate where to go for medical care and treatment. If you’re in Albuquerque, you may be directed to Concentra for medical treatment of your workers’ compensation injuries. If you are not sure where to get treatment, ask your supervisor or employer.

Additionally, the WCA poster should provide contact information for your Employer’s Workers' Compensation insurer and claims representative or adjuster.

Most importantly, the WCA poster should provide Notice of Accident forms.

Unless your boss or supervisor sees you get injured (in which case they have “actual notice” of your workplace injury) then you must notify your employer, in writing, as soon as possible. It is not enough to give verbal notice to your employer or supervisor.

You must fill out a Notice of Accident form, which should be found attached to the WCA poster in your place of employment. An injured worker must fill out, sign, and date the Notice of Accident form and turn it into your employer within 15 calendar days (including weekends and holidays) from “when they knew or should have known” of the occurrence of the accident or injury. The Employer then signs and dates the Notice of Accident and submits it to their Workers’ Compensation insurer. In cases where an injury or illness develops gradually, through repetitive action or exposure, or an injury or illness goes undiagnosed, then the Injured Worker must give notice as soon as may reasonably be done, but no later than 60 days after the occurrence of the accident.

Additionally, there are circumstances in which an Injured Worker does not realize the nature or extent of their injuries or condition for years following an occurrence or exposure at work, which may nonetheless be determined or adjudged to be compensable. If you have any questions regarding an accident, exposure, or injury at work, please call Lueker Law, LLC, to schedule a free consultation regarding your case.

Do you have a Workers’ Compensation or a Personal Injury claim?

Fri, 02 Feb 2024 23:20:31 GMT

Workers’ Compensation

Workers’ Compensation is a no-fault system that is intended to provide medical and indemnity (monetary) benefits to people injured at work in a fast and efficient manner. In New Mexico, if your employer has three or more workers, they are legally required to carry Workers’ Compensation insurance. You don’t need to prove liability or negligence to bring a claim for Workers’ Compensation benefits. The state of New Mexico’s Workers’ Compensation Act provides that the Employer “shall” provide an injured worker with reasonable, necessary, and causally related medical care in a timely manner from an authorized Health Care Provider. The Employer’s Workers’ Compensation insurance adjuster approves medical treatment prescribed by the authorized Health Care Provider. Similarly, if an authorized Health Care Provider finds that an injured Worker cannot return to work as a result of a workplace accident, the Adjuster issues checks for weekly indemnity benefits, equal to two-thirds of the Worker’s pre-injury average weekly wage. When disputes between the injured Worker and the WC insurance adjuster arise, the Worker can file a Complaint with the Workers’ Compensation Administration. The State of New Mexico Workers’ Compensation Administration is an administrative court system that provides alternative dispute resolution services, such as Mediation or Settlement Conferences, to assist in resolving disputed Workers’ Compensation cases. Click here to go to their website. Workers’ Compensation benefits are set out in the Workers’ Compensation Act, which is the exclusive remedy for people who bring a claim against their employer and their Workers’ Compensation insurer for injuries that occur at work.

Personal Injury

However, the Workers’ Compensation Act does not provide the same remedies as a Personal Injury claim, just as a Personal Injury claim does not provide for weekly indemnity benefits or medical benefits subject to approval by a WC insurance adjuster. Personal Injury cases are filed in state district or federal district courts. Personal Injury remedies are broader in scope than the benefits available in a Workers’ Compensation claim. In a Personal Injury lawsuit, a Plaintiff may be able to recover compensatory damages, including economic as well as non-economic damages. Punitive damages may be awarded in certain cases to reprimand or punish the Defendant for their extreme recklessness. Personal Injury and non-economic damages include pain and suffering, mental anguish, loss of enjoyment of life, and loss of consortium. Personal Injury economic damages are meant to reimburse past medical expenses and lost earnings, as well as the projected cost of future medical treatment and care, and loss of future earnings through employment.

Both Workers’ Compensation and Personal Injury

If you're injured at work, then chances are you've got a claim for Workers’ Compensation benefits, which includes both medical and indemnity (money) benefits. But if you were injured because of the actions or inactions of someone other than your employer, such as a third party, then you may have both a Workers’ Compensation and a Personal Injury claim. For example, if you are a driver for UPS and are injured in a motor vehicle accident through no fault of your own, you can bring a Workers’ Compensation claim against your employer as well as a Personal Injury claim against the negligent driver. If you’re injured in an on the job motor vehicle accident, then you may be able to recover Un-Insured/Underinsured Motorists (UM/UIM) benefits from both your Employer’s auto insurance policy as well as your own insurance policy.

However, if you have both a Workers’ Compensation and a Personal Injury claim, there are serious consequences involved in settling one claim before the other. Additionally, there are issues in resolving any subrogation, or reimbursement, claim brought by your employer and workers’ compensation insurer. If you settle a Personal Injury claim arising out of an on-the-job injury, your Employer and its Workers’ Compensation insurer will want to be reimbursed for indemnity and medical benefits paid out in your Workers’ Compensation case. There is a complex formula for calculating how much you may have to pay back to your Employer and its Workers’ Compensation insurer which is explained in the case of Gutierrez v. City of Albuquerque , 1998-NMSC-027, 125 N.M. 643, 964 P.2d 807 (1998). Your Employer should never be fully reimbursed for benefits to which you were entitled. The Employer and its Workers’ Compensation insurer is only entitled to the amount of the Worker’s recovery that is duplicative.

Don’t go it alone. Call Lueker Law, LLC, today for your free 30-minute consultation.

Workers’ Compensation Alphabet Soup

Tue, 17 Jan 2023 23:25:07 GMT

Workers’ Compensation Alphabet Soup

If you’ve been injured at work, chances are you’re learning a new language full of acronyms you’ve never heard before. So, what does it all mean?

DOI: Date of Injury. While an injury can occur in a single event, Injured Workers may suffer from repetitive use or latent injuries, which can complicate when notice of an injury must be given to an Employer, since typically written notice must be given within 15 days of the date of an injury.

HCP: In the state of New Mexico, the Employer has the right to make the initial selection of authorized Health Care Provider. However, chances are, your Employer may have directed you to treat with a particular medical provider, like Concentra, even though you’ve received a letter “giving” you the right to make the initial selection of authorized Health Care Provider. This ruse defeats the concept of choice. Worse still, if you treat with a medical provider who is not an authorized Health Care Provider, then the records of your medical treatment may not be admissible at trial.

AWW: Average Weekly Wage is determined by calculating gross wages over the 6 months prior to DOI.

TTD: If you’re unable to work because of a workplace accident, and you’ve not yet reached Maximum Medical Improvement, then you should receive weekly Temporary Total Disability benefits equal to 2/3 of your pre-injury Average Weekly Wage.

MMI: Maximum Medical Improvement does not mean that an Injured Worker has been restored to their previous condition, prior to the workplace accident. Rather, MMI simply means that an Injured Worker has reached a stable condition, or plateau, in their medical treatment, beyond which no significant improvement is expected, to a reasonable degree of medical probability.

IR: Impairment Rating is the percentage of permanent disability, as determined by an Injured Worker’s authorized Health Care Provider or in an Independent Medical Examination, upon an Injured Worker reaching Maximum Medical Improvement. A permanent Impairment Rating should be based on an accurate assessment your medical condition, based on the most recent edition of the American Medical Association Guides to the Evaluation of Permanent Impairment.

PPD: An Injured Worker is entitled to Permanent Partial Disability modifier benefits upon reaching Maximum Medical Improvement. The type and amount of PPD benefits to which you are entitled depends on the body part(s) affected and the nature of the injuries, as well as a host of other factors, including your age, level of education, job training, whether your employer has offered you post-injury employment, and your post-injury, permanent work restrictions or safe lifting capacity. If you have a Whole Person Injury, or injuries, and your Employer has not made an offer of employment at or above your pre-injury Average Weekly Wage, the Permanent Partial Disability benefits to which you are entitled are expressed as a formula. Contact Lueker Law, LLC, to estimate the Permanent Partial Disability formula modifier benefits to which you’re owed.

LOU: Loss of Use benefits are available for Injured Worker’s with Scheduled Injury claims, i.e., injuries to an extremity or multiple extremities. Upon reaching Maximum Medical Improvement, an Injured Worker with a Loss of Use claim is entitled to a specific number of weeks of indemnity benefits, depending on which part of their body was injured.

WPI: A Whole Person Injury is any injury to the head, shoulders, neck, torso, and hips. Injured Workers with whole person injuries are entitled to different indemnity, or monetary, benefits than Injured Worker’s with Scheduled Injury claims, for Loss of Use.

FCE: Upon reaching Maximum Medical Improvement, an Injured Worker is often sent to Functional Capacity Evaluation to determine their permanent work restrictions. Like an IME, an FCE is not performed by a treating provider. Additionally, the FCE has built in tests designed to indicate if an Injured Worker is or is not giving their full, maximum effort. If you’re scheduled for an FCE, there are things you will want to know before you go.

IME: An Independent Medical Examinations is a medical records review and/or physical examination performed by a physician or a medical provider who is not the Injured Worker’s regular treating provider, or authorized Health Care Provider. There is no doctor-patient relationship, or privilege, that attaches to such examinations. Unless the parties to a Workers’ Compensation case agree to an IME, a Workers’ Compensation Judge must approve the IME, upon application from either the Worker or the Employer/Insurer. IMEs are conducted where the cause of an injury, the nature and extent of injuries, and/or reasonable, necessary, and causally related medical treatment are disputed or unclear.

Call Lueker Law, LLC, today. We’ll spell it out for you.