Obstacles to Claiming Psychiatric Injuries in California Workers’ Compensation

Claims for psychiatric injuries in California workers’ compensation are among the most complex and difficult to pursue. Unlike physical injuries, psychiatric (psych) injury claims are subject to additional statutory requirements, including the six-months of employment and predominant cause requirements, intended to make claiming psych injuries more difficult. Additional complexity comes from both those requirements having expectations. Finally, even if the requirements to bring the claim of injury are met, psychiatric claims are subject to a unique statutory defense.

Six-Month Employment Requirement

A major statutory barrier to a successful claim of psychiatric injury is the six-month employment rule. Generally, an employee must have worked for the employer for at least six months for a psychiatric injury to be compensable. Labor Code § 3208.3(d). This requirement must be satisfied before assessing causation or defenses.

The six months of employment do not need to be continuous, which helps make claims of psychiatric injury possible for seasonal and sporadically or intermittently employed workers.

       Sudden and Extraordinary Exception

There is an exception to the six-month employment requirement. The rule does not apply if the psychiatric injury results from a sudden and extraordinary employment condition. Labor Code § 3208.3(d).
 
Matea v. Workers’ Comp. Appeals Bd. (2006) 144 Cal.App.4th 1435. defined “sudden and extraordinary” events as those that:

• Occur without notice, or with very brief notice;
• Are not foreseen or prepared for;
• Are beyond what is usual and customary for that type of work; and
• Are generally unexpected.

 
Courts have found sudden and extraordinary conditions in cases where a manager at a home improvement store had his leg crushed by falling lumber and where a worker was injured in a fall caused by the ledge he was standing on while installing a sign crumbling. Qualifying an injury as resulting from a sudden and extraordinary event is highly fact-specific and depends on how the injury was sustained and the employee’s job duties when they were injured.
  
Predominant Cause Requirement

Another of the primary hurdles in a psychiatric injury claim is the predominant cause requirement. California law expressly requires that the actual events of employment be the predominant cause of the psychiatric injury. Psychiatric injuries are governed by Labor Code § 3208.3(b)(1), which requires that work-related events are the predominant cause of injury; more than 50%. In other words, the workplace must be the primary cause of the injury, not just a contributing factor.

By contrast, most traditional workers’ compensation injuries are compensable if work caused or contributed to the injury at all, even as little as 1%. Labor Code § 3600(a). In those cases, literally any industrial contribution to the injury is sufficient to meet causation and have a compensable claim warranting workers’ compensation benefits. The predominant cause requirement was passed by the California legislature to intentionally limit compensability for psychiatric claims by imposing a higher standard for success. Labor Code § 3208.3(c).
 
       Violent Act Exception

An exception to the predominant cause requirement is applicable if the workplace injury qualifies as a “violent act”. If the psychiatric injury results from the employee being the victim of a violent act, or from exposure to a significant violent act, the events of employment only need to cause 35% of the psychiatric injury. Labor Code § 3208.3(b)(2). Although this reduced threshold makes some claims of psychiatric injury easier to bring, the violent act exception still aligns with California’s intent to make claiming psychiatric injuries more difficult.

Yet another complication is that qualifying for a “violent act” exception does not fulfill the requirement for a “sudden and extraordinary” exception, and vice versa. The court in Raiszadeh made it clear that “violent acts” and “sudden and extraordinary” are not interchangeable terms and require separate findings for the same employment injury to qualify for a “violent act” and “sudden and extraordinary” exceptions to their respective rules. Raiszadeh v. County of Riverside, 2017 Cal. Wrk. Comp. P.D. LEXIS 225.
 
Good Faith Personnel Action Defense

Even if a claim of injury satisfies both the predominant cause and the six-month employment requirements, the psychiatric claim of injury may be vulnerable to a good faith personnel action defense. Labor Code § 3208.3(h).

A “good faith personnel action” refers to lawful, nondiscriminatory, actions taken by an employer, against an employee. These actions are typically discipline, negative performance evaluations, or demotions (terminations may also be subject to a good faith personnel action defense, but a post-termination defense is likely more applicable and easier to establish). The landmark case for this defense is Rolda v. Pitney Bowes, Inc. (2001) 66 Cal. Comp. Cases 241. Rolda explains the four-part test that includes both legal and medical determinations and requires findings about:

1. Whether the actual events of employment occurred (legal finding);
2. Whether those events were a cause of the psychiatric injury (medical finding);
3. Whether the employment events were a substantial cause of the injury (medical finding); and
4. Whether the events constituted lawful, nondiscriminatory, good faith personnel actions (legal finding).

Because this defense involves overlapping legal and medical findings, successfully defeating it requires careful analysis, developing both medical and factual evidence, and a strong understanding of the medical and legal requirements to satisfy the elements of the defense.

Conclusion:

Psychiatric injury claims in California workers’ compensation are intentionally more difficult to succeed on than standard workers’ compensation injuries. The six-month employment and predominant cause requirements were specifically intended to make it more difficult to bring these claims in the first place. Even if those requirements are fulfilled, defendants may raise any standard defense to the claim of injury in addition to a good faith personnel action defense. It is also worth noting that claiming a psychiatric component of an orthopedic claim of injury presents even more challenges and considerations than a purely psychiatric injury.
​
Although psychiatric injury claims present significant challenges, they can be successfully prosecuted with the right combination of medical evidence and legal expertise. If you believe you have suffered a psychiatric injury arising out of your employment, please reach out to our office.