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Compensability/Mental Trauma (C15)

An accidental mental trauma injury may be compensable when there is evidence of an undesigned, untoward event traceable to a definite time, place, and cause. Transportation Ins. Co. v. Maksyn, 580 S.W.2d 334 (Tex. 1979). However, except as provided below, repetitive mental trauma resulting in injury is not compensable, nor is it considered an occupational disease. Maksyn.

An exception to the non-compensability of a repetitive mental trauma injury is found in Texas Labor Code (TLC) Section 504.019, which addresses coverage for post-traumatic stress disorder (PTSD) for certain first responders. In accordance with an amendment applicable to compensable injuries that occur on or after September 1, 2019, a PTSD claim under that section may be based on more than one event. House Bill 2143 of the regular session of the 86th Texas Legislature.

A mental trauma injury is not compensable if it arises principally from a legitimate personnel action, including a transfer, promotion, demotion or termination. TLC Section 408.006(b); GTE Southwest Incorporated v. Bruce, 998 S.W.2d 605 (Tex. 1999); APD 030169.

Burden of Proof.

The IE has the burden of proof to establish the existence of a compensable mental trauma injury. APD 970292. To establish the existence of a compensable mental trauma injury, the IE must prove the following elements:

  • That a mental trauma injury does in fact exist. Whether an IE in fact has a mental trauma injury must be proven through medical evidence. APD 061729-s. The cause, progression, and aggravation of mental disease is a subject of such a technical nature that expert medical evidence is required. APD 950633. The causal connection between the mental trauma injury and a specific incident at work must be proven through expert medical evidence. APD 960966;
  • That the injury arose within the course and scope of the IE's employment. Chavis v. Director, State Workers' Compensation Div., 924 S.W.2d 439 (Tex. App.-Beaumont 1996, no writ); APD 060176;
  • Subject to the exception for certain first responder PTSD claims applicable to compensable injuries that occur on or after September 1, 2019, that the claimed mental trauma injury is traceable to a definite time, place, and cause. APD 060176; and
  • That the claimed mental trauma injury is not the result of a legitimate personnel action pursuant to TLC Section 408.006. APD 060176.
  • For certain first responder PTSD claims: TLC Section 504.019(a)(2) defines PTSD as a disorder that meets the diagnostic criteria for PTSD specified by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, or a later edition adopted by the commissioner of workers' compensation.
    • For claims for benefits for a compensable injury occurring from September 1, 2017, through August 31, 2019, PTSD suffered by a first responder is a compensable injury if the disorder was caused by an event occurring in the course and scope of the first responder's employment and the preponderance of the evidence indicates that the event was a substantial contributing factor of the disorder.
    • For claims for benefits for a compensable injury occurring beginning on September 1, 2019, PTSD suffered by a first responder is a compensable injury if it is based on a diagnosis that the disorder was caused by one or more events occurring in the course and scope of the first responder's employment and the preponderance of the evidence indicates that the event or events were a producing cause of the disorder.

Elements.

Causal Connection Established.

The IE and her husband worked for a temporary agency and were assigned to a client company. The event giving rise to the mental trauma injury occurred when the IE was working 15 to 20 feet from her husband and his right hand got caught in a machine. The IE testified that she tried to rush to his aid, but that she felt as though someone was holding her back and she was in shock. The injury was very severe and left the IE's husband with little to no use of his right hand. The IE testified that she felt that her husband blamed her for not helping and that she developed guilt about going into shock. The IE presented medical evidence from two health care providers which related her mental problems to her husband's injury event. The ALJ determined that the IE sustained a compensable mental trauma injury. The AP affirmed this determination as being supported by the evidence. APD 000445.

Causal Connection Not Established.

The IE testified that he was employed at a public service agency as an eligibility specialist and his duties involved interviewing people applying for welfare benefits. The IE testified that on a specific date he was interviewing a difficult client who was accompanied by an unruly child. The IE told the child to listen to his mother and the client misunderstood what he said, or meant, and became very irate. The client threatened the IE's job and told him that her husband would be waiting for him after work. After the interview the IE became physically ill due to the threats. The IE reported the incident to his employer, who referred him to a psychologist, who in turn referred him to a psychiatrist. The IE testified that prior to that time, he had never consulted a mental health specialist. The IE presented reports from the psychologist and psychiatrist which addressed his condition, treatment, and inability to work. The ALJ determined that the IE sustained a compensable mental trauma injury. The AP reversed and rendered a decision that the IE did not sustain a compensable mental trauma injury. None of the medical reports mentioned a specific incident at work on the date of the claimed injury. The IE failed to establish a causal connection between his mental trauma injury and a specific incident at work through expert medical evidence. APD 94785.

Course and Scope of Employment Established.

The IE testified that she became the target of unwelcome attention from an unknown coworker. Gifts and cards would be left at her desk and sent to her home. When the IE discovered the identity of the coworker, she and her supervisor confronted him and his attitude toward her became threatening. Because both the IE and her supervisor were afraid the coworker would attack her, the IE was transferred to another building, but the harassment continued. The IE's coworker was becoming more violent so she filed a sexual harassment complaint against him, which resulted in his termination the same day. The IE wanted to go home out of fear, but her supervisor wanted her to stay so that she could be protected. After his termination, and prior to leaving the employer's premises, the coworker came to the IE's work area and attacked her with a knife. The coworker was subdued by several employees and later arrested and convicted. The IE was diagnosed with PTSD as a result of the incident and had not worked since the attack. The ALJ determined that the IE sustained a mental trauma injury in the course and scope of her employment. The IC asserted that the injury did not occur in the course and scope of the IE's employment because it arose out of personal animosity. Whether the IE was in the course and scope of her employment was a question of fact for the ALJ to resolve. APD 022091-s.

Course and Scope Not Established.

The IE was a firefighter who was involved in fighting a large fire. The IE became involved in a threatening situation and was overcome by heat and smoke. He managed to get to safety, cool off, and return to fighting the fire. The IE testified that he had a breakdown 10 days after the fire in question. In his first discussion with a Dr. B, a psychiatrist, the IE attributed his depression and suicidal thoughts to feelings of isolation due to being unmarried, having no relatives living within 1,200 miles, and having no friends outside of work. There was no mention at that time of the fire being a cause of the IE's depression. The IE presented a letter from Dr. F, his treating psychiatrist, which attributed the IE's mental condition to the fire. The ALJ determined that the concurrent report from Dr. B was more credible and determined that the IE did not sustain a mental trauma injury in the course and scope of his employment. Whether the IE's mental trauma injury arose out of the course and scope of his employment was a question of fact for the ALJ to resolve. APD 011026.

Definite Time, Place, and Cause Established.

(This element does not apply to certain first responder PTSD claims for compensable injuries on or after September 1, 2019.) The IE was employed as a paralegal, and notarizing documents was part of her duties. On a certain date, the IE received a letter from the Secretary of State informing her that a complaint had been filed alleging she had notarized a document improperly. The IE was given 20 days to respond to the allegation of misconduct. The IE testified, and presented medical evidence, that she suffered anxiety and depression as a result of the letter. The IC argued that the IE's mental condition was a result of the investigation, thereby making it a case of repetitive mental trauma. The ALJ determined that the IE sustained a compensable mental trauma injury as a result of receiving the letter. Whether the IE's mental trauma injury arose out of an event which occurred at a definite, time, place, and cause was a question of fact for the ALJ to resolve. APD 990261.

Definite Time, Place, and Cause Not Established.

The IE was employed as an administrative clerk. The IE testified that she had been diagnosed with depression and attention deficit disorder prior to her claimed mental trauma injury, but that these conditions did not affect her work. The IE testified that on the date of the claimed injury, a coworker had told her that everybody knew about a sexual harassment claim the IE had filed, that coworkers were calling her names behind her back, and that her phone at work was being tapped. The IE worked for two more days until she saw her doctor and was taken off work and given anti-anxiety medication. Additional evidence showed that the IE had been written up for tardiness prior to the claimed date of injury. The ALJ determined that the IE did not sustain a compensable mental trauma injury because her stress was due to repetitively stressful events at work. The evidence supported a determination that the IE's mental trauma involved several different mentally traumatic events, including being written up for tardiness prior to the claimed date of injury, the alleged sexual harassment itself, and gossip about her sexual harassment complaint. Whether the IE sustained a compensable mental trauma injury is a question of fact for the ALJ to resolve. APD 980074.

Legitimate Personnel Action Established.

The IE testified that she worked in a laboratory. The IE testified that she was terminated but that the termination was not the cause of her depression, mental trauma, and inability to work. Rather, she alleged it was the manner in which her supervisor terminated her. The IE described shouting, waving of arms, and a slapping of her hand when she sought to take her rolodex with her. The IE testified that she became very afraid of the supervisor and ran from the building. The IE was later diagnosed with a mental trauma injury attributable to the events surrounding the firing. The IC presented evidence from the supervisor in question as well as the personnel director, who was present at the time of the firing. Both denied the events to which the IE testified. The IC witnesses denied any shouting, arm waving, slapping or grabbing. The personnel director testified that she walked out the building with the IE. The ALJ determined that the IE did not sustain a compensable mental trauma injury, and that the termination was a legitimate personnel action. Whether the IE sustained a compensable mental trauma injury is a question of fact for the ALJ to resolve. APD 980583.

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