Effectively Managing Questionable Stress Claims
Legitimate psychiatric stress claims do exist. However, many employers find themselves faced with employee claims of mental stress that do not qualify as compensable under workers’ compensation law.
Situations that lead to questionable stress claim filings include:
- Angry employees
- Low employee morale
- Poorly performing employees on formal disciplinary plans
- Employees with attendance issues
Defending Against Stress Claims
The first step to take when a psychiatric claim is filed: conduct a thorough factual and medical based investigation of the claim.
If the investigation determines the claim has been filed following disciplinary action, the Good Faith Personnel Action Defense (GFPAD) can be argued. In order for the GFPAD to be effective, the following must occur:
- Timely identification of circumstances
- Well documented personnel actions
- Evidence of strict adherence to proper personnel procedures will be critical for success
Successfully Utilizing the Good-Faith Personnel Action Defense
The GFPAD is detailed in Labor Code §3208.1(h). A good-faith personnel action exists when a regular and routine employment decision is carried out in a reasonable manner with no hint of improper methodology. To be successful in baring a psychiatric claim based on this defense, an employer must demonstrate that the “substantial cause” of the injury was a good faith personnel action. Substantial cause is defined as 35% to 40% of the injury.
To mount a successful defense, the employer and claims administrator must conduct the investigation with the realization that if the claim were to go to trial, the judge will utilize a multi-level analysis mandated by the en banc decision in Rolda v. Pitney Bowes. The judge’s analysis will involve four steps to determine:
- Whether the psychiatric injury involved actual events of employment (factual-legal determination).
- Whether the medical evidence establishes that the events of employment was the predominant cause (greater than 50%) of the injury.
- Whether the actual employment events were personnel actions that were lawful, non-discriminatory and made in good faith.
- Whether the good faith personnel actions were a substantial cause (35% – 40%) of the injury.
In order for a successful GFPAD defense, it is imperative that the claims administrator obtain personnel records, medical records, and statements or depositions from all parties and provide this information to the evaluating doctor in order to present a competent defense before the Workers’ Compensation Appeals Board.
Click on the link below for a recent example of a good faith personnel defense case:
County of Sacramento v. Workers’ Compensation Appeals Board (Michael Brooks) (2011)
Increasing the Chances for a Positive Stress Claim Outcome
Defending stress claims can be extremely challenging for employers. By understanding the process and having solid personnel performance documentation and procedures in place within your organization, the potential for a positive claims defense outcome will be greatly enhanced. It is also critical to provide your claims administrator with as much information as possible, and to maintain constant communication with them regarding the investigative process.