ARE PTSD CLAIMS COMPENSABLE IN WEST VIRGINIA?
As a general principal in West Virginia, a claimant is precluded from receiving workers’ compensation benefits for a mental injury with no physical cause. West Virginia, like most other states, provides that for workers’ compensation purposes, no alleged injury or disease shall be recognized as a compensable injury or disease, which was solely caused by non-physical means and which did not result in any physical injury or disease to the person claiming benefits. The purpose of W. Va. Code § 23-4-1f is to clarify that “mental-mental claims” are not compensable for workers’ compensation purposes in West Virginia.
In 2013, however, the West Virginia Supreme Court of Appeals found that a United Parcel Service driver, who was physically detained by a gunman and assaulted by the sound of gun fire, had a compensable PTSD claim based upon the fact that there was a physical component to the incident and the claimant had actually received a personal injury (some scrapes and abrasions). The Supreme Court specifically noted that following the incident, the claimant experienced multiple symptoms of PTSD, including sleep disturbances, nightmares and depression. The Court specifically held that the claim for PTSD was not barred by W. Va. Code § 23-4-1f because his condition was manifested by demonstrable physical symptoms, including sleep disturbances and jumpiness. Essentially, the Supreme Court found that the claimant’s PTSD was compensable, as the incident with the gunman was physical in nature and because his condition manifested physical symptoms. Generally, psychological injuries that result from a physical injury are compensable.
Recently, the Supreme Court addressed this issue again where the claimant had no physical injury and was not involved in any type of physical altercation, but still alleged that she suffered PTSD. In this situation, the claimant was assisting other workers in mixing acetic acid when a fire broke out. The incident involved a fire in the outdoor containment area of an acid storage tank. The fire damaged the tank to the point that it failed and began releasing acid to the tank dike. The plant was evacuated and authorities responded, including the hazardous materials team. The police evacuated a nearby neighborhood and the fire department put out the fire. There were no physical injuries associated with the event and no release of acid into the environment.
However, the claimant witnessed the fire and began treatment with a counselor after she reported that she panicked and saw her life flash before her eyes. For several days after the fire, the claimant could not work because she shook uncontrollably, vomited and felt ill. She reported recurrent visions in her mind of the flames and that she could not concentrate because of anxiety and problems sleeping. The claimant was diagnosed with PTSD and was treated with eye movement desensitization and reprocessing therapy. The claimant was treated weekly and could not return to work due to her physical symptoms from her PTSD. She treated with a psychiatrist and took medication for this disorder.
The claims administrator denied the claim for PTSD; however, the West Virginia Insurance Commission Office of Judges reversed that decision and determined that the claimant’s PTSD was received in the course of and as a result of her employment. The Office of Judges concluded that the claimant had PTSD because the medical records indicated that she suffered from the condition and that she had physical manifestations of her mental injury. The Office of Judges recognized that the precipitating incident in the decision described above with the UPS driver arguably had more physical elements, but then went on to find that the claimant’s physical manifestations of her mental injury were quite similar to that of the UPS driver. Accordingly, the Office of Judges concluded that the claim was compensable for post-traumatic stress disorder.
On appeal, the West Virginia Insurance Commission Board of Review reversed that decision and found that the claimant’s injury was not caused by a physical means and had absolutely no physical component to the actual injury, causing the injury to fall directly into the category of claims prohibited by the state code section. The West Virginia Supreme Court of Appeals agreed with that decision in a memorandum order and specifically found that the claimant failed to show a physical means sufficient enough to overcome the mandate in W. Va. Code § 23-4-1f in order for the claim to be ruled compensable for PTSD.
This recent decision by the West Virginia Supreme Court of Appeals shows that West Virginia still squarely falls into the category of states that do not allow mental-mental workers’ compensation claims. At present, 19 states do allow for these mental-mental claims. However, in West Virginia, it is clear that the claimant must show some physical component to the actual injury in order for a post-traumatic stress disorder claim to be considered a compensable injury for workers’ compensation purposes.