AROUND THE NATION
Methodology: States providing “mental-mental” (mental injury with a mental cause) coverage in their workers’ compensation policies were derived from news articles, state codes, passed laws, state workers’ compensation websites, court cases, legal firms and legislation trackers. Then, additions were made based on state laws specifically regarding coverage for mental injury with regards to first responders. Finally, the results were cross-referenced with outside work such as research published by Psychological Trauma: Theory, Research, Practice, and Policy (Wise and Beck, 2015), and a 2017 publication by the National Council on Compensation Insurance. In the event of discrepancies, we made the final call based on primary sources. Click on each state to learn about their policies for workers' compensation.
WORKERS' COMPENSATION LAWS STATE BY STATE:
“Injury does not include a mental disorder or mental injury that has neither been produced nor been proximately caused by some physical injury to the body”
(b) Compensation and benefits under this chapter are not payable for mental injury caused by mental stress, unless it is established that (1) the work stress was extraordinary and unusual in comparison to pressures and tensions experienced by individuals in a comparable work environment; and (2) the work stress was the predominant cause of the mental injury. The amount of work stress shall be measured by actual events. A mental injury is not considered to arise out of and in the course of employment if it results from a disciplinary action, work evaluation, job transfer, layoff, demotion, termination, or similar action taken in good faith by the employer.
“B. A mental injury, illness or condition shall not be considered a personal injury by accident arising out of and in the course of employment and is not compensable pursuant to this chapter unless some unexpected, unusual or extraordinary stress related to the employment or some physical injury related to the employment was a substantial contributing cause of the mental injury, illness or condition.”
“A mental injury or illness is not a compensable injury unless it is caused by physical injury to the employee's body, and shall not be considered an injury arising out of and in the course of employment or compensable unless it is demonstrated by a preponderance of the evidence; provided, however, that this physical injury limitation shall not apply to any victim of a crime of violence.”
“(a) A psychiatric injury shall be compensable if it is a mental disorder which causes disability or need for medical treatment, and it is diagnosed pursuant to procedures promulgated under paragraph (4) of subdivision (j) of Section 139.2 or, until these procedures are promulgated, it is diagnosed using the terminology and criteria of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, or the terminology and diagnostic criteria of other psychiatric diagnostic manuals generally approved and accepted nationally by practitioners in the field of psychiatric medicine.”
“(2) (a) A claim of mental impairment must be proven by evidence supported by the testimony of a licensed physician or psychologist. For purposes of this subsection (2), "mental impairment" means a recognized, permanent disability arising from an accidental injury arising out of and in the course of employment when the accidental injury involves no physical injury and consists of a psychologically traumatic event that is generally outside of a worker's usual experience and would evoke significant symptoms of distress in a worker in similar circumstances.”
Sec. 31-294h. Benefits for police officers and firefighters suffering mental or emotional impairment. Notwithstanding any provision of this chapter, workers’ compensation benefits for any (1) police officer, as defined in subparagraph (B)(ii) of subdivision (16) of section 31-275, who suffers a mental or emotional impairment arising from such police officer’s use of deadly force or subjection to deadly force in the line of duty, or (2) firefighter, as defined in subparagraph (B)(ii) of subdivision (16) of section 31-275, who suffers a mental or emotional impairment diagnosed as post-traumatic stress disorder originating from the firefighter witnessing the death of another firefighter while engaged in the line of duty, shall be limited to treatment by a psychologist or a psychiatrist who is on the approved list of practicing physicians established by the chairman of the Workers’ Compensation Commission pursuant to section 31-280.
“The State of Delaware recognizes a compensable mental injury absent any physical trauma. State v. Cephas, 637 A. 2d. 20 (del. 1994). The claimant must prove that the mental illness was the result of stressful working conditions by an objective causal nexis test. The claimant must prove both the existence of the stressful working conditions and relate those conditions to the mental disorder. The standard whether the working conditions were a substantial cause of the claimant’s condition.”
“In general, disability causally related to psychological injuries is compensable if the employee establishes that the psychological injury resulted from a specific identifiable source within the obligations or conditions of the employment, rather than the employee's perceived conditions of the employment. Psychological injury cases are compensable regardless of the Claimant’s pre-existing condition. The test for psychological injury is subjective rather than objective.”
“A mental or nervous injury due to stress, fright, or excitement only is not an injury by accident arising out of the employment. Nothing in this section shall be construed to allow for the payment of benefits under this chapter for mental or nervous injuries without an accompanying physical injury requiring medical treatment. A physical injury resulting from mental or nervous injuries unaccompanied by physical trauma requiring medical treatment shall not be compensable under this chapter.”
“In Georgia, a psychic injury is compensable only if it satisfies a two-prong test: (1) it must arise out of an accident in which a compensable physical injury was sustained; and (2) while the physical injury need not be the precipitating cause of the psychological condition or problems, the physical injury must, at a minimum, contribute to the continuation of the psychological trauma”
“"Disability" means loss or impairment of a physical or mental function.”
“Mental disabilities arising out of employment are compensable. 53 H. 32, 487 P.2d 278.”
“Psychological injuries, disorders or conditions shall not be compensated under this title, unless the following conditions are met: (1) Such injuries of any kind or nature emanating from the workplace shall be compensated only if caused by accident and physical injury as defined in section 72-102(18)(a) through (18)(c)”
“Under certain circumstances, an injured worker can obtain Illinois workers’ compensation benefits for purely psychological injuries. These “mental-mental” cases occur when an injured worker sustains psychological injuries as a result of non-physical work-related factors. There are two types of these cases: 1) where the employee suffers a sudden, severe emotional shock traceable to a specific incident, or 2) where the employee develops a psychological injury after a series of work-related events.”
“Q. Are psychological injuries covered by the Act? A. Yes, as long as they arose out of the course of your employment.”
“The general rule is that in order to prove a mental-mental injury, the claimant must establish both 1) medical causation, meaning that the mental stimuli actually caused the mental injury; and 2) legal causation, meaning that the workplace stress is of a greater magnitude than the stresses experienced by other workers in the same or similar job, regardless of the employer. Dunlavey v. Economy Fire & Cas. Co., 526 N.W.2d 845, 855 (Iowa 1995). However, when a claim is based on a manifest happening of a sudden traumatic nature from an unexpected cause or unusual strain, the legal-causation test is met irrespective of the absence of similar stress on other employees. Brown v. Quik Trip, 641 N.W.2d 725 (Iowa 2002) (finding compensable an injury from a holdup at gunpoint as a sudden traumatic event).”
“"Personal injury" and "injury" mean any lesion or change in the physical structure of the body, causing damage or harm thereto.”
“‘Injury’ when used generally, unless the context indicates otherwise, shall include an occupational disease and damage to a prosthetic appliance, but shall not include a psychological, psychiatric, or stress-related change in the human organism, unless it is a direct result of a physical injury”
“Mental injury or illness resulting from work-related stress shall not be considered a personal injury by accident arising out of and in the course of employment and is not compensable pursuant to this Chapter, unless the mental injury was the result of a sudden, unexpected, and extraordinary stress related to the employment and is demonstrated by clear and convincing evidence.”
“Mental injury resulting from work-related stress does not arise out of and in the course of employment unless it is demonstrated by clear and convincing evidence that: A. The work stress was extraordinary and unusual in comparison to pressures and tensions experienced by the average employee; and [1991, c. 885, Pt. A, §8 (NEW); 1991, c. 885, Pt. A, §§9-11 (AFF).] B. The work stress, and not some other source of stress, was the predominant cause of the mental injury. [1991, c. 885, Pt. A, §8 (NEW); 1991, c. 885, Pt. A, §§9-11 (AFF).]”
“We take this as the present status of the law of Maryland in tort actions, damages may be recovered for emotional distress capable of objective determination. In other words, under Vance's definition of "physical injury", damages resulting from harm psychological in nature may be obtained, independent of physiological harm, provided the cause and effect of psychological harm are established.”
Maryland Court of Appeals in Belcher v. T. Rowe Price Foundation, Inc
“Personal injuries shall include mental or emotional disabilities only where the predominant contributing cause of such disability is an event or series of events occurring within any employment.”
“In cases of heart disease, mental disabilities, and conditions of the aging process, the worker must prove that the employment aggravated or accelerated the condition in a significant manner. In cases of mental disability, the condition must be caused by actual events of employment.”
- Bureau of Workers' Disability Compensation Michigan Department of Consumer & Industry Services
“Minnesota law does not allow compensation for cases in which mental stress or stimulus produces only mental injury except for post-traumatic stress disorder for injuries on or after Oct. 1, 2013.”
- Minnesota Department of Labor & Industry Workers' Compensation Division
“When mental stress leads to mental injury without a physical injury, the claim could be compensable, but the claimant has a burden of proving more than the allegation that “my job drove me crazy”. For a “mental-mental” injury to be compensable, the claimant bears the burden of proving, by clear and convincing evidence, that the mental injury resulted from “more than the ordinary incidents of employment” and that there was an “untoward event or unusual occurrence” that contributed to the mental or emotional injury. The claimant’s burden of proof is greater than that encountered in proving compensability in a physical injury situation, and all of the cases are factually intensive.”
- Mississippi Workers' Compensation Adjuster's Guide
"The forfeiture of benefits or compensation shall not apply when:... Mental injury resulting from work-related stress does not arise out of and in the course of the employment, unless it is demonstrated that the stress is work related and was extraordinary and unusual. The amount of work stress shall be measured by objective standards and actual events."
“stress claims, often referred to as "mental-mental claims" and "mental-physical claims", are not compensable under Montana's workers' compensation and occupational disease laws. The legislature recognizes that these claims are difficult to objectively verify and that the claims have a potential to place an economic burden on the workers' compensation and occupational disease system.”
“1) Personal injury includes mental injuries and mental illness unaccompanied by physical injury for an employee who is a first responder if such first responder: (a) Establishes, by a preponderance of the evidence, that the employee's employment conditions causing the mental injury or mental illness were extraordinary and unusual in comparison to the normal conditions of the particular employment; and (b) Establishes, by a preponderance of the evidence, the medical causation between the mental injury or mental illness and the employment conditions by medical evidence. (2) For purposes of this section, mental injuries and mental illness 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 and 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.”
“NRS 616C.180 Injury or disease caused by stress. 1. Except as otherwise provided in this section, an injury or disease sustained by an employee that is caused by stress is compensable pursuant to the provisions of chapters 616A to 616D, inclusive, or chapter 617 of NRS if it arose out of and in the course of his or her employment. 2. Any ailment or disorder caused by any gradual mental stimulus, and any death or disability ensuing therefrom, shall be deemed not to be an injury or disease arising out of and in the course of employment. 3. An injury or disease caused by stress shall be deemed to arise out of and in the course of employment only if the employee proves by clear and convincing medical or psychiatric evidence that: (a) The employee has a mental injury caused by extreme stress in time of danger; (b) The primary cause of the injury was an event that arose out of and during the course of his or her employment; and (c) The stress was not caused by his or her layoff, the termination of his or her employment or any disciplinary action taken against him or her. 4. The provisions of this section do not apply to a person who is claiming compensation pursuant to NRS 617.457. (Added to NRS by 1993, 663; A 1993, 2445) — (Substituted in revision for NRS 616.5019)”
“The workers’ compensation law allows compensation for mental health and stress disorders so long as the disorder is caused by the worker’s employment, is not due to good faith evaluation, discipline, termination or similar actions by the employer, and results in physical symptoms.”
“New Jersey has developed a four part test to determine whether pure mental injury claims are compensable. (1) the claimant must show that the working conditions in question are stressful; (2) the evidence must show that the claimant reacted to them as stressful; (3) the conditions must be “peculiar” to the workplace; and (4) there must be objective evidence supporting a medical opion [sic] of the resulting psychiatric disability. Goyden v. State Judiciary, 256 N.J. Super. 438, 607 A.2d 651 (1991); aff’d, 128 N.J. 54, 607 A.2d 622 (1992).”
“Primary mental impairment is the worker’s loss of ability to function mentally or emotionally at a normal level, due to a severe and unusual event — not ordinary workplace stresses. A worker who has a primary mental impairment may receive benefits calculated as a number of weeks of TTD. Primary mental impairment may occur when there is no physical injury.”
- New Mexico Workers' Compensation Administration
“According to the New York State Workers' Compensation Board, a work-related injury is only compensable if it arises directly in the course of an employee's job. Workers may show that psychological injuries arose in the course of employment in various ways, including the following: The injury was a byproduct of an established physical work-related injury. The injury occurred as the result of a traumatic incident that occurred while the employee was performing his or her job. The injury developed as the cumulative result of adverse conditions that the employee faced in the course of his or her work.”
“The North Carolina courts have held that benefits may be awarded for work related mental illnesses under a catch-all provision of the state’s occupational disease statute, which defines a non-listed occupational disease as: ‘[a]ny disease … which is proven to be due to causes and conditions which are characteristic of and peculiar to a particular trade, occupation or employment, but excluding all ordinary diseases of life to which the general public is equally exposed outside of the employment.’”
- Patterson, Harkavy & Lawrence, L.L.P.
“The term ("Compensable injury") does not include:...A mental injury arising from mental stimulus.”
“Ohio’s workers’ compensation system is liable for psychiatric injuries, but only if related to a physical injury. Under current Ohio law, a purely psychiatric injury, even if arising out of the work-place, is not compensable. There must be a concurrent or preceding physical injury.”
“A mental injury or illness is not a compensable injury unless caused by a physical injury to the employee, and shall not be considered an injury arising out of and in the course and scope of employment or compensable unless demonstrated by a preponderance of the evidence; provided, however, that this physical injury limitation shall not apply to any victim of a crime of violence.”
“As used in this chapter, “occupational disease” means any disease or infection arising out of and in the course of employment caused by substances or activities to which an employee is not ordinarily subjected or exposed other than during a period of regular actual employment therein, and which requires medical services or results in disability or death, including: (A) Any disease or infection caused by ingestion of, absorption of, inhalation of or contact with dust, fumes, vapors, gases, radiation or other substances. (B) Any mental disorder, whether sudden or gradual in onset, which requires medical services or results in physical or mental disability or death. (C) Any series of traumatic events or occurrences which requires medical services or results in physical disability or death. (b) As used in this chapter, “mental disorder” includes any physical disorder caused or worsened by mental stress. (2)(a) The worker must prove that employment conditions were the major contributing cause of the disease. (b) If the occupational disease claim is based on the worsening of a preexisting disease or condition pursuant to ORS 656.005 (7), the worker must prove that employment conditions were the major contributing cause of the combined condition and pathological worsening of the disease. (c) Occupational diseases shall be subject to all of the same limitations and exclusions as accidental injuries under ORS 656.005 (7). (d) Existence of an occupational disease or worsening of a preexisting disease must be established by medical evidence supported by objective findings. (e) Preexisting conditions shall be deemed causes in determining major contributing cause under this section. (3) Notwithstanding any other provision of this chapter, a mental disorder is not compensable under this chapter unless the worker establishes all of the following: (a) The employment conditions producing the mental disorder exist in a real and objective sense. (b) The employment conditions producing the mental disorder are conditions other than conditions generally inherent in every working situation or reasonable disciplinary, corrective or job performance evaluation actions by the employer, or cessation of employment or employment decisions attendant upon ordinary business or financial cycles. (c) There is a diagnosis of a mental or emotional disorder which is generally recognized in the medical or psychological community. (d) There is clear and convincing evidence that the mental disorder arose out of and in the course of employment. (4) Death, disability or impairment of health of firefighters of any political division who have completed five or more years of employment as firefighters, caused by any disease of the lungs or respiratory tract, hypertension or cardiovascular-renal disease, and resulting from their employment as firefighters is an “occupational disease.” Any condition or impairment of health arising under this subsection shall be presumed to result from a firefighter’s employment. However, any such firefighter must have taken a physical examination upon becoming a firefighter, or subsequently thereto, which failed to reveal any evidence of such condition or impairment of health which preexisted employment. Denial of a claim for any condition or impairment of health arising under this subsection must be on the basis of clear and convincing medical evidence that the cause of the condition or impairment is unrelated to the firefighter’s employment.”
“to succeed in establishing a Workers’ Compensation claim for a mental/mental injury (mental stimulus/mental injury), the employee must demonstrate that the injury resulted from an abnormal working condition. Historically, this has been a difficult burden for employees to meet.”
“(36) The disablement of an employee resulting from mental injury caused or accompanied by identifiable physical trauma or from a mental injury caused by emotional stress resulting from a situation of greater dimensions than the day-to-day emotional strain and tension which all employees encounter daily without serious mental injury shall be treated as an injury as defined in § 28-29-2(7).”
“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.”
“The term does not include a mental injury arising from emotional, mental, or nonphysical stress or stimuli. A mental injury is compensable only if a compensable physical injury is and remains a major contributing cause of the mental injury, as shown by clear and convincing evidence.”
- South Dakota Department of Labor and Regulation
“(12) ‘Injury’ and ‘personal injury’ mean an injury by accident arising out of and in the course of employment that causes either disablement or death of the employee and shall include occupational diseases arising out of and in the course of employment that cause either disablement or death of the employee and shall include a mental injury arising out of and in the course of employment … (15) Mental injury means a loss of mental faculties or a mental or behavioral disorder where the proximate cause is a compensable physical injury resulting in a permanent disability, or an identifiable work-related event resulting in a sudden or unusual mental stimulus.”
“"Occupational disease" means a disease arising out of and in the course of employment that causes damage or harm to the physical structure of the body, including a repetitive trauma injury. The term includes a disease or infection that naturally results from the work-related disease. The term does not include an ordinary disease of life to which the general public is exposed outside of employment, unless that disease is an incident to a compensable injury or occupational disease. … (a) It is the express intent of the legislature that nothing in this subtitle shall be construed to limit or expand recovery in cases of mental trauma injuries. (b) A mental or emotional injury that arises principally from a legitimate personnel action, including a transfer, promotion, demotion, or termination, is not a compensable injury under this subtitle.”
“34A-2-402. Mental stress claims. (1) Physical, mental, or emotional injuries related to mental stress arising out of and in the course of employment shall be compensable under this chapter only when there is a sufficient legal and medical causal connection between the employee's injury and employment. (2) (a) Legal causation requires proof of extraordinary mental stress from a sudden stimulus arising predominantly and directly from employment. (b) The extraordinary and sudden nature of the alleged mental stress is judged according to an objective standard in comparison with contemporary national employment and nonemployment life. (3) Medical causation requires proof that the physical, mental, or emotional injury was medically caused by the mental stress that is the legal cause of the physical, mental, or emotional injury.”
“The Department has interpreted the term “personal injury” to include a mental injury. The two types of mental injury claims recognized under Vermont’s Workers’ Compensation Act are “physical-mental” and “mental-mental” claims.”
“A psychiatric or psychological claim may be compensable if it flows from some physical impact or injury. In the absence of physical impact or injury, it is necessary that the psychological injury result from a sudden shock or fright which is out of the ordinary in terms of the employee's duties and so dramatic or frightening as to shock the conscience.”
“(2)(a) Stress resulting from exposure to a single traumatic event will be adjudicated as an industrial injury. See RCW 51.08.100. (b) Examples of single traumatic events include: Actual or threatened death, actual or threatened physical assault, actual or threatened sexual assault, and life-threatening traumatic injury. (c) These exposures must occur in one of the following ways: (i) Directly experiencing the traumatic event; (ii) Witnessing, in person, the event as it occurred to others; or (iii) Extreme exposure to aversive details of the traumatic event. (d) Repeated exposure to traumatic events, none of which are a single traumatic event as defined in subsection (2)(b) and (c) of this section, is not an industrial injury (see RCW 51.08.100) or an occupational disease (see RCW 51.08.142). A single traumatic event as defined in subsection (2)(b) and (c) of this section that occurs within a series of exposures will be adjudicated as an industrial injury (see RCW 51.08.100).”
§23-4-1f. Certain psychiatric injuries and diseases not compensable.
For the purposes of this chapter, no alleged injury or disease shall be recognized as a compensable injury or disease which was solely caused by nonphysical means and which did not result in any physical injury or disease to the person claiming benefits. It is the purpose of this section to clarify that so-called mental-mental claims are not compensable under this chapter.
Mental harm including nervous disorders, hysteria, and traumatic neurosis. The effects of brain hemorrhage caused by an industrial accident may also result in such harm. If the injury is mental harm or emotional stress without a physical trauma, the injured employee must show that it resulted from a situation of greater dimensions than the day-to-day mental stresses and tensions which all employees experience.
“"Injury" does not include:... (J) Any mental injury unless it is caused by a compensable physical injury, it occurs subsequent to or simultaneously with, the physical injury and it is established by clear and convincing evidence, which shall include a diagnosis by a licensed psychiatrist or licensed clinical psychologist meeting criteria established in the most recent edition of the diagnostic and statistical manual of mental disorders published by the American Psychiatric Association.”
DISCLAIMER: It is particularly difficult to label or categorize a state, as the different laws, practices and court interpretations between states vary. Thus, the information presented should not be interpreted as cut and dry or set in stone; rather, a guide to the general ability to receive mental-mental workers’ compensation. For example, many states provide mental health-related worker’s compensation given “unusual” or “extraordinary” circumstances. Whether a police officer having to discharge their weapon or whether a firefighter seeing a child die is “unusual” or “extraordinary” is up for interpretation by multiple state-level institutions..