Workers compensation claims and pre-existing psychological conditions

Have you submitted, or are considering submitting, a workers compensation claim for a psychological injury, but have been diagnosed with a psychological condition in the past? Find out whether it will affect your claim.

Workers compensation claims for psychological injuries

More workers are submitting workers compensation claims for psychological conditions than ever before[1] as the stigma around mental health decreases. Whether someone is being bullied by a colleague or manager, given an unreasonable workload, or even experiences a traumatic incident at work, these types of situations can often lead to psychological conditions such as anxiety, depression and post-traumatic stress disorder. It is common for workers to have experienced some sort of psychological condition in the past – everyone at some point in their life has struggled with mental health. Usually, they have done the right thing and sought medical treatment and/or counselling. But should a worker disclose that to the insurance company? The short answer, is yes.

What does the law say?

The definition of ‘injury’ in workers compensation law is contained in section 4 of the Workers Compensation Act 1987 (NSW). It includes a ‘disease injury’ – that is, a disease which a worker contracts during their employment, or the aggravation, acceleration, exacerbation or deterioration of a disease. Generally, psychological conditions are, for the purpose of workers compensation law, considered a ‘disease.’ In order for a claim to be accepted, the worker’s employment must be the main contributing factor to the disease (or the aggravation, acceleration, exacerbation or deterioration of it).

Pre-existing and past psychological conditions

For workers with pre-existing psychological conditions, their employment needs to be the main contributing factor to the aggravation, acceleration, exacerbation or deterioration of their condition. The original condition does not need to be work-related. For example, a worker may have suffered from anxiety for several years (caused by non-work related factors) which they had always managed well with the help of regular counselling, and it never impacted their ability to work. Suddenly, a new manager is employed, who begins bullying them. This severely increases their anxiety, so much so that they cannot work and they lodge a claim. In that instance, if employment is the main contributing factor to the aggravation, acceleration, exacerbation or deterioration of the worker’s anxiety (which depends on medical opinion) the claim should be accepted.

Sometimes, workers may not have a pre-existing psychological condition, but may have had in the past. For example, a worker may have suffered from depression following a marriage breakdown several years ago, was prescribed anti-depressant medication, and then completed recovered. Now, several years later, they experience difficulties at work and are diagnosed with depression again. Generally, this past psychological history will not affect a worker’s claim so long as they are truthful about their past condition.

What you should do

It is important to always be honest with your treating doctors, medico-legal examiners and investigators about your past psychological history. If you don’t fully disclose your past psychological history, it will almost certainly come to light during the workers compensation process. Insurance companies often request your clinical records from your current and past doctors and conduct searches in order to obtain your past workers compensation claim files. If you don’t disclose past psychological conditions, it can affect your credibility later on in your workers compensation claim process.

It is also a requirement when submitting a claim to complete a Worker’s Injury Claim Form, in which you are required to disclose whether you have previously had another injury/condition that relates to the current injury/condition. By signing the claim form, you are attesting that the information provided is true and correct to the best of your knowledge. Similarly, if you make a claim for lump sum compensation for permanent impairment, you are required to sign a Permanent Impairment Claim Form which requires you to disclose if there is any pre-existing condition or previous injury to which any proportion of the impairment may be due. Falsely answering a question is fraudulent, and punishable by law.

Seek legal advice

If you have a past or pre-existing psychological condition and are concerned about how it may affect your claim, you should seek legal advice. Please contact our experienced Workers’ Compensation Lawyers at Turner Freeman on 13 43 63.

[1] NSW Workers Compensation Statistical Bulletin 2016/17, State Insurance Regulatory Authority.