When workers experience work-related illnesses or injuries, they’re typically entitled to workers’ compensation insurance – but what if the illness or injury isn’t physical in nature? Stress and mental health issues have received increased attention in recent years, with some states passing laws to expand coverage for stress and mental health workers’ compensation claims.

The Health Impact of Stress

It’s easy to dismiss stress as a normal part of life, but when stress is excessive, it may be detrimental to a person’s physical and mental health.

The Mayo Clinic says chronic stress may increase a person’s risk for many health problems, including anxiety, depression, sleep problems, memory and focus problems, weight gain, digestive issues, headaches, muscle pain, heart disease, heart attack, high blood pressure, and stroke.

People who witness or experience extremely stressful or frightening events may develop post-traumatic stress disorder (PTSD). Indiana University Health says people with PTSD are stuck in “fight or flight” mode and unable to relax. They may struggle with anxiety and depression and may have trouble concentrating or maintaining employment.

Although PTSD is often associated with military service, it may be triggered by extreme events in any environment, including work. First responders are particularly vulnerable due to the nature of their work. According to the National Alliance on Mental Illness, it’s estimated that 18% to 24% of dispatchers and 35% of police officers suffer from PTSD. Many self-medicate with alcohol or other self-destructive or abusive behaviors.

Even workers in less stressful jobs may experience PTSD due to extreme situations, such as a workplace shooting. Research published in the American Journal of Psychiatry found that 36% of women and 20% of men met the criteria for a PTSD diagnosis one month after a mass shooting event. 

Workers’ Compensation for Stress, PTSD, and Other Mental Illnesses

If workers suffer debilitating stress or PTSD after a work-related trauma, it seems sensible that they would qualify for workers’ compensation. However, claims are not always simple.

It may be difficult to prove that a person is experiencing severe mental health issues and even harder to prove that the person’s work is the cause of those issues. In one case, Property Casualty 360 says a worker claimed to be totally and permanently disabled due to PTSD brought on by witnessing a shooting at work. Her employer argued that her mental health issues were caused by other events and stressors. The Special Workers’ Compensation Appeal Panel of the Supreme Court of Tennessee ruled in favor of the worker.

Claims may also be challenged if the triggering event is not considered exceptional. According to Weber Gallagher LLP, a bus driver in New York tried to claim workers’ compensation for PTSD after an angry passenger banged on the door and jumped on the front bumper. The claim was denied because such interactions between bus drivers and unruly passengers are considered part of the normal work environment.

The Current Workers’ Compensation Landscape

Whether a worker can receive workers’ compensation benefits for a mental injury comes down to several factors, namely:

• The type of job. In many states, it’s easier for first responders to claim workers’ compensation for mental injuries.
• The nature of the injury. Workers’ compensation is more likely to cover mental injuries that accompany physical injuries. It is also more likely to cover mental injuries caused by extreme events, such as mass shootings.
• The state. State law varies significantly and is still evolving.

In Oregon, SB 507 made it easier for public safety workers to receive workers’ compensation for claims involving PTSD and acute stress disorder. If employers have medical evidence that work events did not cause the condition, they can refute the claim, but otherwise, the condition is presumed to be a compensable occupational injury. The law applies to claims filed on of after September 29, 2019.

Oregon is not the only state to pass legislation of this nature. A 2024 report from the Kansas Legislative Research Department found that 41 states provide workers’ compensation for mental-only injuries. However, 26 of these states only cover mental workplace injuries for first responders or mental workplace injuries that are accompanied by a physical injury.

Furthermore, 2024 research published in the Journal of Public Health Policy found that only nine states have enacted presumption laws for mental health injuries that reduce the burden of proof required from workers. In states without these laws, workers may face challenges trying to prove that their mental injuries were caused by work.

Although there has been a trend toward increasing coverage for mental injuries, not all states are on board. According to EMS1, the governor of Montana recently vetoed a bill that would have let first responders receive workers’ compensation benefits for PTSD. Critics of the bill argued it wasn’t fair to single out first responders and that it would disrupt the workers’ compensation system.

Helping Workers After Traumatic Events

After a traumatic event, workers may struggle with mental health issues, even if they did not suffer physical harm. In some states, they may be able to claim workers’ compensation for their mental injuries. Regardless, they may need support before they are able return to work.

Employers can help by taking mental health seriously and providing resources. In addition to a workers’ compensation program that addresses mental health, employers can offer other mental health benefits, such as Employee Assistance Programs and remote counseling.

Do you need help keeping up with workers’ compensation laws and trends? LaPorte can help you take control of your workers’ compensation program. Our insurance program administration will help you maximize your premium value now, while our claims management assistance and loss prevention consultation will help you keep your future costs down.