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Disability Benefits for Mental Health Conditions:

Posted by Foster Law on November 19, 2013

Typically, industrial injury or occupational disease claims begin with a traumatic physical injury or the development of a physical condition over time from repetitive activity at work. As a result, many benefits payable under the Washington State Industrial Insurance Act are contingent upon the existence of “objective findings” substantiating disability based upon physical injuries or conditions. However, it is not uncommon for injured workers to develop mental health conditions that are causally related to the industrial injury or occupational disease. Unlike physical conditions, medical evidence of objective findings of mental health conditions and the extent of disability stemming from mental health conditions are not required. Therefore, in assessing disability, a medical provider may rely upon an injured worker's subjective statements of symptoms or complaints.

Even though medical providers may rely upon “subjective complaints,” it is nevertheless important that medical providers thoroughly document all mental health diagnoses, the basis for the diagnoses, the limitations imposed by the diagnoses, and the severity and bases for the limitations imposed. Such thorough documentation is needed so that the Department of Labor and Industries or third party administrator can properly provide benefits to the injured worker. In addition, this type of documentation is necessary when assessing any permanent partial disability stemming from mental health conditions. The categories of impairment for mental health conditions are set out in WAC 296-20-340 as follows:

Category 1: Nervousness, irritability, worry or lack of motivation following an injury and commensurate with it and/or other situational responses to injury that do not alter significantly the life adjustment of the patient may be present.

Category 2: Any and all permanent worsenings of preexisting personality traits or character disorders where aggravation of preexisting personality trait or character disorder is the major diagnosis; mild loss of insight, mildly deficient judgment, or rare difficulty in controlling behavior, anxiety with feelings of tension that occasionally limit activity; lack of energy or mild apathy with malaise; brief phobic reactions under usually avoidable conditions; mildly unusual and overly rigid responses that cause mild disturbance in personal or social adjustment; rare and usually self-limiting psycho-physiological reactions; episodic hysterical or conversion reactions with occasional self-limiting losses of physical functions; a history of misinterpreted conversations or events, which is not a preoccupation; is aware of being absentminded, forgetful, thinking slowly occasionally or recognizes some unusual thoughts; mild behavior deviations not particularly disturbing to others; shows mild over-activity or depression; personal appearance is mildly unkempt. Despite such features, productive activity is possible most of the time. If organicity is present, some difficulty may exist with orientation; language skills, comprehension, memory; judgment; capacity to make decisions; insight; or unusual social behavior; but the patient is able to carry out usual work day activities unassisted.

Category 3: Episodic loss of self-control with risk of causing damage to the community or self; moments of morbid apprehension; periodic depression that disturbs sleep and eating habits or causes loss of interest in usual daily activities but self-care is not a problem; fear-motivated behavior causing mild interference with daily life, frequent emotogenic organ dysfunctions requiring treatment; obsessive-compulsive reactions which limit usual activity; periodic losses of physical function from hysterical or conversion reactions; disturbed perception in that patient does not always distinguish daydreams from reality; recognizes his fantasies about power and money are unusual and tends to keep them secret; thought disturbances cause patient to fear the presence of serious mental trouble; deviant social behavior can be controlled on request; exhibits periodic lack of appropriate emotional control; mild disturbance from organic brain disease such that a few work day activities require supervision.

Category 4: Very poor judgment, marked apprehension with startle reactions, foreboding leading to indecision, fear of being alone and/or insomnia; some psychomotor retardation or suicidal preoccupation; fear-motivated behavior causing moderate interference with daily life; frequently recurrent and disruptive organ dysfunction with pathology of organ or tissues; obsessive-compulsive reactions causing inability to work with others or adapt; episodic losses of physical function from hysterical or conversion reactions lasting longer than several weeks; misperceptions including sense of persecution or grandiosity which may cause domineering, irritable or suspicious behavior; thought disturbance causing memory loss that interferes with work or recreation; periods of confusion or vivid daydreams that cause withdrawal or reverie; deviations in social behavior which cause concern to others; lack of emotional control that is a nuisance to family and associates; moderate disturbance from organic brain disease such as to require a moderate amount of supervision and direction of work day activities.

Category 5: Marked apprehension so as to interfere with memory and concentration and/or to disturb markedly personal relationships; depression causing marked loss of interest in daily activities, loss of weight, unkempt appearance, marked psycho-motor retardation, suicidal preoccupation or attempts, or marked agitation as well as depression; marked phobic reactions with bizarre and disruptive behavior; psychophysiological reactions resulting in lasting organ or tissue damage; obsessive-compulsive reactions that preclude patient's usual activity; frequent or persistent loss of function from conversion or hysterical reactions with regressive tissue or organ change; defects in perception including frank illusions or hallucinations occupying much of the patient's time; behavior deviations so marked as to interfere seriously with the physical or mental well-being or activities of others; lack of emotional control including marked irritability or overactivity.

At Foster Law, P.C. we are expert, we are fierce, and we are compassionate. Our team offers decades of experience to helping literally thousands of injured workers obtain the benefits that are so crucial to maintaining their welfare and that of their families. If you have any questions or concerns about mental health conditions accepted under industrial injury or occupational disease claims, we invite you to contact us. Initial consultations are complimentary. Don't leave your workers' compensation claim to chance; consult with experts.

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