Untangling Mental-Mental Claims: Challenges and Best Practices for Workers’ Compensation Professionals 

Shantalia Osborne 

As conversations about mental health become more open and widespread, workers’ compensation systems are grappling with claims that do not fit neatly into traditional, physically oriented models of injury. Nowhere is this tension more visible than in mental-mental claims, or cases where a psychological injury arises from a purely psychological workplace stressor, without any accompanying physical trauma. For many workers’ compensation professionals, these are among the most challenging cases to investigate, evaluate, and resolve. 

Unlike physical-mental or mental-physical claims, both of which most states recognize as compensable in some form, mental-mental injuries remain the least uniformly accepted. Some jurisdictions allow them under narrow conditions; others deny them outright. Furthermore, even where compensability exists, evidentiary burdens are often high and complex. However, despite inconsistent legislation across states, these claims are appearing more frequently across industries. For claims professionals, risk managers, attorneys, and clinicians, understanding how to navigate them is becoming essential. 

Mental-mental claims present a unique mix of legal, medical, and operational challenges because they break from the traditional workers’ compensation framework built around objectively verifiable physical injuries. Without a physical event to anchor causation, these claims rely heavily on subjective reporting and clinical interpretation. States also impose very stringent standards, requiring proof of “extraordinary” stress, objective medical evidence, or predominant causation. This means adjusters must collect and assess information that is more nuanced than what is typically required in physical injury claims. 

Because of this complexity, workers’ compensation professionals benefit from adopting an intentionally structured approach early in the life of a mental-mental claim. One of the most effective strategies is to begin not with the diagnosis but with a factual, chronological timeline. Identifying what occurred, who witnessed it, whether the event or stressor was part of the employee’s usual job duties, and whether the reaction was immediate or cumulative can guide the claim’s direction before medical evidence even enters the picture. Building this timeline also helps clarify whether the alleged incident has the potential to meet the state’s statutory requirements for compensability. This approach saves time and reduces disputes later. 

Reviewing pre-existing mental health history is an essential component, though it must be handled with sensitivity and professionalism. Most states permit employers to explore prior diagnoses or personal stressors when determining causation, especially in jurisdictions that require work to be the predominant cause of the psychological condition. The main goal is understanding how work-related factors intersect with non-work-related ones. Partnering early with behavioral health experts can help differentiate between new pathology, exacerbation of pre-existing conditions, and symptoms rooted in personal issues. This distinction becomes critical when evaluating whether the workplace stressor meets stringent statutory thresholds. 

At the same time, adjusters must also document job-specific stress levels, because several states require that the stressor be outside what similarly situated employees typically experience. This means collecting job descriptions, speaking with supervisors, reviewing relevant records, and developing a clear understanding of the day-to-day realities of the position. Claims professionals handling cases involving law enforcement, healthcare, or emergency services must pay particular attention to how courts in their jurisdiction differentiate routine exposure from extraordinary events. Understanding whether the incident is typical for the occupation helps clarify whether the statutory standard is met. It also guides the nature of medical and legal evaluations. 

Given that mental-mental claims often hinge on expert opinion, the selection and guidance of clinicians is especially important. Not all mental health providers understand workers’ compensation requirements. Evaluations are most effective when completed by specialists who can clearly address statutory language, causation standards, and the interplay between work and non-work factors. The most useful evaluations do more than state a diagnosis; they describe functional limitations, anticipated duration, recommended treatment, and return-to-work considerations. These details help adjusters and attorneys assess compensability and develop appropriate plans to avoid unnecessary litigation. 

Given the contested nature of mental-mental claims, collaboration between adjusters and legal counsel should begin early. Attorneys can help interpret whether the alleged stressor meets the statutory threshold and ensure that investigative steps align with established case law. Legal guidance is also essential when drafting questions for independent medical evaluations (IME). IMEs in these claims should use the exact language of the relevant statute, focusing on whether the stressor was “extraordinary,” “unexpected,” or the “predominant cause” of the claimed condition. 

Many states remain conservative in their treatment of mental-mental claims, but others have gradually expanded coverage. Even in restrictive jurisdictions, the conversation around workplace mental health continues to evolve. Courts are increasingly asked to weigh cumulative stress and non-traditional forms of trauma. For workers’ compensation professionals, the most important takeaway is that mental-mental claims will likely continue increasing in frequency and complexity. 

Successfully managing these claims requires structured investigation, thoughtful clinical collaboration, and early legal strategy. While mental-mental injuries may never fit neatly into the traditional workers’ compensation model, professionals who adapt their processes to these unique demands will be better equipped to handle these claims and preserve the integrity of the system. 

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