Legitimacy of workers comp stress claims highlights need for quick action, expert evaluation


By Stephen M. Pfeiffer, PhD

Workers comp fraud prevention and related reform efforts receive the lion’s share of media coverage when it comes to California employee benefits and claims. However, while reform may be both necessary and imminent, as noted in a recent

Business Insurance

report, it is important for both employers and legislators to recognize that some of the most superficially dubious cases – specifically those dealing with work-induced stress from sexual harassment, trauma or other causes – are also the most frequently justified.

According to a definitive


conducted by psychiatric and legal scholars at the University of Hawaii, most stress-related compensation claims are genuine; and yet, because such claims are both psychologically complex and generally less apparent than prominent physical injuries, they are also among the claims most likely to arouse employer suspicion, prolonged benefit negotiations and accusations of fraudulent behavior. In the push to both reduce employer costs and increase laborer’s benefits throughout California, it is important to highlight the trends impacting problematic compensation cases – and come to a better understanding of those cases in order to ensure a just system that maximizes employee chances of returning to work.

Defining and identifying workplace stress for swift action and effective treatment

Workplace stress and subsequent suffering can arise from a variety of causes, including sexual harassment, bearing witness to a traumatic incident, bullying and other psychological pressures. Because people experience such events differently, and subsequently undergo changes in stress-related illnesses on a highly individualized basis, it can be particularly difficult for employers and litigators to assess the legitimacy of such stress claims. In addition, the confusion that stress-related illnesses can induce in some patients can result in a tendency to exaggerate symptoms and even imagine new symptoms in an effort to be heard and taken seriously.

Return to Work experts suggest that positive communication to a trusted administrator or colleague is one of the best and most effective ways for workers to present stress claims. However, because of the many mental and emotional factors involved, it is important for employers to provide avenues for open communication and understanding in order to achieve early resolution, treatment, and a return to productivity on the part of the employee.

Unfortunately, it is not always possible for employers and injured workers to resolve stress-related illness issues without prompting the filing of a workers compensation claim. Once a claim is lodged, there is a high likelihood of increased distress on the part of the claimant (and in some cases, an even greater chance of suspicion on the part of the employer). Under such circumstances, it is critical for litigators to seek out the services of an experienced

Qualified Medical Evaluator

in order to asses the legitimacy of the worker’s claim and provide an expert perspective on the case. To learn more about workers compensation medical evaluations, visit my website: