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Can I get workers’ compensation coverage for mental illness?

The National Institute of Mental Health estimates that one in five adults struggle with mental illness. This translates to over fifty-seven million Americans in 2021. In addition to this high number that recognize their own mental health concerns the stigma around seeking help for this medical issue has changed. People are now fighting for those with mental illness to get the treatment and support they need.

In addition to the shift in the public perception around mental health on a broad scale, the vast majority of the public has voiced concern the aftermath of the COVID-19 pandemic will continue to fuel a rise in these numbers and could result in a national mental health crisis. Although mental health issues were experienced most notably in the emergency responder community as nurses and other healthcare professionals rose to the challenge of providing care during the pandemic, the call for isolation and lack of information of the danger of the virus during the first year of the pandemic was a recipe for a mental health disaster for everyone regardless of their profession.

Anxiety and depression can result in crippling symptoms, making it difficult if not impossible to complete one’s work obligations. This leads to questions about the ability to get workers’ compensation when suffering from a mental illness.

How does workers’ compensation work when it comes to mental health?

The rules are guided by state, not federal, law. Although many states provide coverage, workers can find difficulty making the connection between their mental illness and their work. Without this clear connection it is difficult to establish that workers’ compensation coverage should apply. This means that issues that stem from stress from the pandemic alone are not likely to trigger coverage. An event or exposure at work is generally required.

Workers’ compensation coverage is often available after a workplace injury or illness. Mental health can qualify as an illness — more specifically as an occupational disease.

Maryland law defines this as an “ailment, disorder, or illness” that can extend to include mental illness but, as noted above, the connection between the illness and work is often the biggest hurdle to coverage.

Another potential issue is the need to establish that the mental illness disrupts the ability to do the job. Some tips that can help increase the likelihood of a successful claim include:

  • Document the incident. Take the time to take notes about the events that led to the mental injury. This can include the date, location, and names of any witnesses. Again, to qualify for coverage it must generally have occurred during the course of employment.
  • Keep records of diagnosis and treatment. Keep records of the time, location, and discussions during any psychologist, psychiatrist, counseling or other related medical visits and appointments.
  • Consider use of experts. It is possible that you may need to fight for coverage. This could include the need to use experts to help establish your claim.

These are complex and difficult to establish claims. It is often wise to bring in legal counsel to help better ensure you have everything in order to better ensure coverage.

Are there any changes to the current rules?

It is important to note that just like our perception of mental illness the rules and regulations that guide coverage are evolving. The National Council on Compensation Insurance (NCCI), an organization that focuses on providing information about workers’ compensation and related issues, dives into the latest changes with an annual report. The report breaks down different proposals throughout the country and notes which have passed, and which are still under consideration.

According to the most recent report, which focused on trends during the 2022 legislative session, although concerns regarding coverage and COVID-19 still top the list, states throughout the country were also considering dozens of bills that specifically addressed workplace-related mental injuries like post-traumatic stress disorder (PTSD). Lawmakers in Maryland were considering a bill that would establish a presumption of coverage for 9-1-1 specialists who are diagnosed with PTSD. As of the writing of the report, that bill had not yet passed. The issue was discussed in more detail in a previous piece, available here.

There are two important lessons from these trends: coverage expansion for both pandemic related injuries and mental health illnesses. We will continue to provide updates on these changes as they become available. In the meantime, those who suffer from either as a result of an on-the-job injury are wise to seek legal counsel to help better ensure they receive the coverage they are entitled.

  • AABA