MENTAL STRESS INJURY OR GOOD-FAITH PERSONNEL ACTION - Effectively Managing Questionable Stress Claims

About Athens Administrators

Athens Administrators is a TPA for workers’ compensation and liability claims. We have successfully administered claims for more than 30 years. Our clients include public agencies, regional businesses, insurance companies and Fortune 500 companies. We provide workers’ compensation and liability claim administration services.

For more information
please contact:

Northern California
Bruce Lees
925.826.1103

Southern California
Michael Landa
909.451.1710

Toll Free
866.482.3535

info@athensadmin.com

• Established 1976
• Privately Owned
• 160+ Employees

www.athensadmin.com

MENTAL STRESS INJURY OR GOOD-FAITH PERSONNEL ACTION?

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

Employers do have defenses against psychiatric claims. A powerful key argument is the Good-Faith Personnel Action Defense.

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.