Mental injury claims, often stemming from workplace stressors, are on the rise and can create major headaches for employers. Understanding the relationship between stress in the workplace and resulting mental and physical disorders, such as psychiatric disorders or cardiovascular disease, isn’t easy.  Often there are more questions than answers. Can stress lead to anxiety attacks or depression? Can job induced stress cause your blood pressure to rise? Could it cause a heart attack or cardiac condition? How do we separate work-related from non-work related causes?

A recent estimate from the National Institutes of Health projected that the cost to the American economy of stress related health claims is close to $150 billion per year.  The cost is reflected in decreased productivity, absenteeism and massive increases in medical treatment costs.  Accordingly, it is not uncommon for corporations to spend millions of dollars each year on “stress management” programs.  As claims of stress-related mental illness and cardiovascular injury continue to rise, it becomes increasingly important for companies to be able to distinguish cases of compensable work-related stress from other non-compensable situations.  To do so, the employer must have a good working knowledge of some of the medical concepts associated with stress, and the legal framework within which these concepts will be applied.  To assist employers in this regard, Part 1 of this blog post will provide an overview of the general concepts and part 2 will explore some of the more recent Pennsylvania cases.

Employers familiar with mental injury claims will recall that Pennsylvania law distinguishes between three (3) types of mental injury cases – – physical/mental (a physical stimulus causing mental injury), mental/physical (a mental or emotional experience causing physical consequences), and pure mental/mental cases (mental or emotional stimulus causing purely emotional sequelae).

The above distinctions are important because differing burdens of proof apply depending on the proper categorization of the case.  In physical/mental and mental/physical cases, the Claimant need only establish, by a preponderance of the evidence, that his or her injuries arose in the course and scope of employment.  A higher burden of proof, however, attaches to mental/mental injuries and to prevail in these cases, the Claimant must demonstrate the presence of “abnormal working conditions.”

The best example of a “physical/mental” case involves an amputation or orthopedic injury of sufficient severity to necessitate later psychological counseling or psychiatric treatment for a condition such as depression or PTSD.  The mirror image of the physical/mental case is the so-called “mental/physical” case, which involves a work-related mental stimulus, triggering physical injury or illness.  Sometimes a heart attack or cardiac condition can qualify as a compensable event under this standard. A determination of causal connectedness to work often depends on medical evidence and opinion.  Although employees often file claims for depression and anxiety caused by general workplace stress, these claims usually are not compensable, because these are mental/mental claims and the abnormal work condition requirement is difficult to meet. Although difficult to prove, mental/mental cases, where an alleged abnormal working condition creates a mental stressor that in turn produces a mental or emotional disability, are the most hotly litigated.  These are highly fact specific cases with significant emotional investment by the Claimant. The heightened burden of proof (i.e. presence of an abnormal working condition) is typically found to have been met only where a mental disability is directly caused by a violation of law, such as sex, age, race or disability discrimination, or by some workplace event that is totally unexpected and abnormal with respect to Claimant’s specific employment (i.e. a police officer who witnesses a shooting has not necessarily been exposed to an abnormal working condition, absent additional facts).

The Pennsylvania Supreme Court held benefits were proper in a mental/mental case involving a coal miner with a pre-existing post-traumatic stress disorder.  The pre-existing condition, of which the employer was aware, had been caused by unwelcome homosexual propositions from his commanding officer, while initially serving in the U.S. Army in Vietnam.  The worker successfully argued that his underlying condition was materially aggravated by a series of three incidents over eight (8) days, during which his boss made comments in the presence of other workers, implying that he wanted to have sex with Claimant.  The employer offered testimony to establish that the comments were no different from the regular crude banter that often takes place between coal miners, and therefore did not constitute abnormal working conditions.  The Pennsylvania Supreme Court disagreed, noting that there had been sufficient evidence of a “course of conduct on the part of a supervisory employee, clearly calculated to cause severe emotional distress.”  Accordingly, the claimant met his burden of showing that he suffered from a mental injury, which involved more than a mere subjective reaction to normal working conditions.  RAG & (Cyprus) Emerald Resources v. WCAB (PA Supreme Court 2007).

With the foregoing legal framework in mind, in Part 2 of this blog post, we will explore more recent developments in the mental/mental line of cases and provide some practical insights as to how you can protect your company from work-related stress claims.