ARE MENTAL HEALTH INJURIES COVERED BY WORKERS’ COMPENSATION IN SC?

People are hurt or killed on the job every day in America, and they are usually covered by workers’ compensation insurance – what about mental health injuries, though? Are mental health injuries covered by workers’ compensation in SC?

Post-traumatic stress disorder (PTSD), extreme stressful conditions on the job, and the costs of hospitalization, treatment, and counseling for mental health injuries suffered on the job may be covered by workers’ compensation in SC if there is:

• An accompanying physical injury; or
• Extraordinary circumstances on the job that caused the injuries even when there is no accompanying physical injury.

Below, we’ll look at how “injury” is defined for purposes of workers’ compensation coverage in SC and some examples of when mental health injuries are covered by workers’ compensation in SC.

WHEN ARE MENTAL HEALTH INJURIES COVERED BY WORKERS’ COMPENSATION IN SC?

Mental health injuries, including stress, mental illness, and physical conditions like a heart attack or stroke, may or may not be covered depending on how the injury happened, whether there is an accompanying physical injury and whether your condition meets the definition of “injury” under SC’s workers’ compensation laws.

How is “Injury” Defined by Workers’ Compensation Law in SC?

SC Code Section 42-1-160 defines “injury” and “personal injury” for purposes of workers’ compensation coverage in SC.

Under SC’s workers’ compensation laws, “injury” means: “only injury by accident arising out of and in the course of employment…”

But what about stress, mental illness, or physical conditions like a heart attack that may have been caused by on-the-job stress?

ARE MENTAL HEALTH INJURIES COVERED BY WORKERS’ COMPENSATION WHEN THERE IS NO PHYSICAL INJURY?

Section 42-1-160 says that mental health injuries are covered by workers’ compensation insurance in SC when there is no accompanying physical injury if 1) the work conditions that led to the injury were extraordinary and unusual, and 2) you can prove with medical evidence that the stressful work conditions caused the mental health injury:

(B) Stress, mental injuries, and mental illness arising out of and in the course of employment unaccompanied by physical injury and resulting in mental illness or injury are not considered a personal injury unless the employee establishes, by a preponderance of the evidence:

(1) that the employee’s employment conditions causing the stress, mental injury, or mental illness were extraordinary and unusual in comparison to the normal conditions of the particular employment; and

(2) the medical causation between the stress, mental injury, or mental illness, and the stressful employment conditions by medical evidence.

Bentley v. Spartanburg County

For example, in Bentley v. Spartanburg County, the SC Supreme Court denied mental health benefits to a Spartanburg County sheriff’s deputy who shot and killed a suspect.

After the shooting, Bentley suffered from severe anxiety and depression and was unable to continue working in law enforcement (as an aside, the family of the man he killed also sued the county for wrongful death and was compensated in a confidential settlement).

The workers’ compensation commission denied his benefits, and the Supreme Court agreed, because 1) there was no accompanying physical injury, and 2) shooting and killing a person is not an “unusual or extraordinary” condition of employment for a law enforcement officer.

Although the use of deadly force is not unusual or extraordinary for a police officer, what if it were a grocery store clerk who was forced to defend themselves?

In most jobs, it would be “unusual or extraordinary” for a person to be forced to defend themselves or to survive a physical assault, and, for most categories of employees, workers’ compensation should provide benefits in this situation even where there is no accompanying physical injury.

Doe v. SC Dept. of Disabilities and Special Needs

In Doe v. SC Dept. of Disabilities and Special Needs, the SC Supreme Court held that mental health injuries suffered by a nurse were covered by workers’ compensation in SC where:

• The Department consolidated aggressive and passive patient populations in Ms. Doe’s unit, resulting in an unexpected increase in violence and aggressive behavior;
• Doe suffered minor physical injuries which included having feces smeared in her face;
• Doe was treated and hospitalized for severe depression; and
• Medical experts testified that her depression was caused by her work conditions.

Although there were minor accompanying injuries, the court analyzed the case as if there were no accompanying injuries. Still, they found that she was entitled to benefits because the work conditions were unusual and extraordinary – the department mixed aggressive and passive patients in her unit which was something that she was not trained for or prepared to handle.

ARE MENTAL HEALTH INJURIES COVERED BY WORKERS’ COMPENSATION WHEN THERE IS A PHYSICAL INJURY?

Stress, mental health injuries, or mental illness that is caused by or aggravated by a physical injury on the job is covered by workers’ compensation when causation can be proven.

SC Code Section 42-1-160 states that causation can be proven if it is admitted by the employer or if it is affirmed by a physician, psychologist, or psychiatrist:

(D) Stress, mental injuries, and mental illness alleged to have been aggravated by a work-related physical injury may not be found compensable unless the aggravation is:

(1) admitted by the employer/carrier;

(2) noted in a medical record of an authorized physician that, in the physician’s opinion, the condition is at least in part causally related or connected to the injury or accident, whether or not the physician refers the employee for treatment of the condition;

(3) found to be causally related or connected to the accident or injury after evaluation by an authorized psychologist or psychiatrist; or

(4) noted in a medical record or report of the employee’s physician as causally related or connected to the injury or accident.

Does Workers’ Compensation Cover a Heart Attack or Stroke While on the Job?

Heart attacks or strokes that are brought on by on-the-job stress or a stressful event at the workplace are a different situation. In a sense, it’s a physical injury caused by a mental health injury – is that covered by workers’ compensation?

SC Code Section 42-1-160 says that heart attacks or strokes that are caused by ordinary employer/employee relations are not covered by worker’s comp unless the situation is extraordinary and unusual:

(C) Stress, mental injuries, heart attacks, strokes, embolisms, or aneurisms arising out of and in the course of employment unaccompanied by physical injury are not considered compensable if they result from any event or series of events which are incidental to normal employer/employee relations including, but not limited to, personnel actions by the employer such as disciplinary actions, work evaluations, transfers, promotions, demotions, salary reviews, or terminations, except when these actions are taken in an extraordinary and unusual manner.

So, there are three situations where workers’ compensation may cover a heart attack or stroke:

• When it is accompanied by a physical injury;
• When it is caused by an unusual event that is not “incidental to normal employer/employee relations;” and
• When it is caused by “normal employer/employee relations” that are “taken in an extraordinary and extreme manner.”

GOT AXELROD?

If you have suffered a mental health-related injury while on the job in SC, your Myrtle Beach Workers’ Compensation attorney at Axelrod and Associates can help you to determine whether your mental health injuries are covered by worker’s compensation.

Call now at 843-353-3449 or send us a message online to talk set up a free consultation with a SC workers’ compensation lawyer today.