PTSD and Workers' Compensation: The Difficulty of a Proper Diagnosis

Recently, there has been increasing discussion about Post Traumatic Stress Disorder (PTSD), not only in the general population but also in the workers’ compensation realm in regards to COVID-19. From the workers’ compensation perspective, the compensability of mental health disorders varies state by state. However, for the purpose of this discussion, the diagnosis, treatment and prognosis of PTSD is the focus.

It is normal for an individual to react emotionally to an unexpected injury or event disturbing to them. This response can include symptoms such as irritability, anxiety, depression and insomnia. These symptoms most often resolve on their own, with only a small percentage of people who experience a traumatic event developing symptoms consistent with PTSD. In PTSD, the symptoms last for longer than a month and interfere with a person’s daily life, such as work and relationships. A holistic evaluation of an individual, their history, environment, support systems, etc., are also key in determining a diagnosis and appropriate treatment plan.

It is important to have the correct medical professional specialist diagnose and treat an individual with potential mental health concerns. These professionals include psychologists, clinical social workers and psychiatrists.

The Diagnostic and Statistical Manual of Mental Health Disorders 5^th edition (DSM-5) is a reference handbook published by the American Psychiatric Association for mental health clinicians to diagnose mental health conditions. Per the DSM-5, for a PTSD diagnosis, the precipitating event should meet the following criteria:

1. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 in the manual does not apply to exposure through electronic media, television, movies or pictures unless this exposure is work-related. The trauma must be actually experienced.

Appropriate treatment for PTSD can include psychotherapy and medications. Another type of psychotherapy recognized by the American Psychiatric Association, WHO and the DOD that is highly effective for treating trauma is Eye Movement Desensitization and Reprocessing (EMDR), which works to process targeted memories in an eight-phase treatment approach utilizing eye movements and reprocessing memories.

Most individuals will have their symptoms resolve with appropriate treatment. However, for some, there can be flare-ups of symptoms in the future.

Some injured employees experience symptoms following a traumatic event that don’t rise to the level of a diagnosable mental health condition. Again, mental health is covered differently in each state and is a highly complex issue, and establishing a straight “mental-mental” claim requires very strict criteria. Traditionally, treatment for these symptoms would not be covered as a part of the workers’ compensation claim. In the industry, there has been discussion about how to meet the needs of these employees without accepting compensability of a mental health issue. This topic is likely to grow more pressing as incidents such as COVID-19 and its variants continue to impact workers.

By Lynn Timmons

Lynn Timmons is Director of Medical Case Management for Amtrust Financial Services. Lynn has been in the industry for over 15 years and has a special interest in the biopsychosocial approach to workers’ compensation injuries and chronic pain management. Contact her at Lynn.Timmons@amtrustgroup.com.

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