Filing a Psych Claim: Workers' Comp for Stress & PTSD in California
Psychological injury claims are the most challenging -- and most stigmatized -- category of workers' comp cases in California. From PTSD after a workplace assault to chronic depression caused by a hostile work environment, these claims are real, valid, and compensable. But California imposes stricter legal standards on psych claims than on any other injury type. Settlements typically range from $25,000 to $100,000 or more. This guide explains exactly what it takes to win a psychiatric injury claim.
How Psychological Injury Claims Work in California
California workers' compensation law recognizes psychiatric injuries as compensable conditions -- but the Legislature has placed significant restrictions on these claims that do not apply to physical injuries. Understanding these restrictions is essential before filing.
Under Labor Code §3600, workers' compensation covers injuries "arising out of and in the course of employment." For psychiatric injuries, California Labor Code Section 3208.3 adds specific requirements that make these claims harder to prove:
Key Requirements for Psych Claims
- 1. Six-month employment rule: You must have been employed by the employer for at least six months before the psychiatric injury is compensable -- unless the injury was caused by a sudden and extraordinary employment condition (such as witnessing a violent crime or being physically assaulted at work).
- 2. Predominant cause standard: Actual events of employment must be the predominant cause (at least 51%) of your psychiatric injury. This is significantly higher than the "contributing cause" threshold for physical injuries.
- 3. Good faith personnel actions defense: If the employer demonstrates that the psych injury was "substantially caused" by lawful, nondiscriminatory, good faith personnel actions (performance reviews, discipline, termination), the claim is not compensable.
- 4. Actual events of employment: The psychiatric injury must be caused by real workplace conditions -- not the employee's misperception of events. The evaluating physician must determine whether the stressors were objectively real.
Types of Compensable Psychological Injuries
California workers' comp covers several categories of psychiatric conditions when they result from employment:
Post-Traumatic Stress Disorder (PTSD)
PTSD develops after experiencing or witnessing a traumatic event. In the workplace context, this includes robberies, assaults, witnessing a coworker's death or severe injury, active shooter situations, and first responder exposure to graphic scenes. PTSD claims tend to be the strongest psych claims because the triggering event is concrete, identifiable, and clearly work-related.
Major Depressive Disorder
Workplace depression can result from chronic harassment, bullying, unrelenting workload pressure, or the aftermath of a serious physical work injury. When a physical injury leads to depression -- for example, a construction worker who becomes severely depressed after a disabling back injury ends his career -- the psychiatric component is treated as a "consequence" injury and has a lower burden of proof than a stand-alone psych claim.
Generalized Anxiety Disorder
Chronic workplace anxiety can be compensable when it results from actual employment conditions such as threats of violence, unsafe working conditions, or sustained hostile work environments. The key is demonstrating that the anxiety is disproportionate to normal workplace stress and was caused predominantly by work conditions.
Adjustment Disorder
Adjustment disorder is a stress-related condition that develops in response to a significant change or stressor. In workers' comp, this diagnosis is common when a worker struggles to adapt after a physical injury, job loss, or major change in working conditions. While generally considered less severe than major depression or PTSD, adjustment disorder is still compensable and adds value to a claim.
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The "Predominant Cause" Standard: What It Really Means
The predominant cause standard is the biggest legal obstacle in most psych claims. The evaluating psychiatrist must weigh all contributing causes of your condition -- both work-related and personal -- and conclude that employment was responsible for at least 51% of your psychiatric injury.
This analysis is intensely personal and invasive. The evaluating psychiatrist will explore your entire mental health history, including:
- Prior psychiatric treatment or hospitalizations
- History of childhood trauma or abuse
- Current relationship and family stress
- Financial difficulties unrelated to work
- Substance abuse history
- Genetic predisposition to mental health conditions
- Pre-existing anxiety, depression, or other diagnoses
The insurer will use any non-work stressor to argue that employment was not the predominant cause. This is why preparation is critical. Before your psychiatric evaluation, work with your attorney to create a thorough timeline of workplace stressors and document exactly how your work conditions caused or worsened your condition.
Important Exception: Physical-Mental Claims
When a psychiatric injury is a direct consequence of a physical work injury, the predominant cause standard does not apply. Instead, you only need to show that the physical injury was a contributing cause of the psychiatric condition -- a much lower bar. For example, if you develop severe depression after a disabling back injury, the depression is treated as a consequence of the physical injury, and the six-month employment requirement also does not apply.
How Insurers Fight Psych Claims
Insurance companies deny psychological injury claims at significantly higher rates than physical injury claims. Here are their most common tactics:
1. The "Good Faith Personnel Action" Defense
If your psychiatric injury followed a negative performance review, disciplinary action, or termination, the insurer will argue it was caused by legitimate personnel actions -- not compensable working conditions. This defense is powerful but has limits: if the personnel actions were discriminatory, retaliatory, or carried out in bad faith, the defense fails. For more on retaliation protections, see our guide on employer retaliation in workers' comp.
2. Blaming Personal Stressors
The insurer's psychiatrist will aggressively probe your personal life looking for non-work stressors to push the causation below 51%. A recent divorce, a child's health issues, financial trouble, or a family death will all be used to argue that work was not the predominant cause. Knowing this in advance allows you to prepare an accurate picture that does not minimize work stressors.
3. Challenging the Diagnosis
Insurers may argue that your symptoms do not meet the diagnostic criteria for PTSD, major depression, or the claimed condition. They may send you to a QME psychiatrist who minimizes or recharacterizes your symptoms. Understanding what to expect at your psychiatric evaluation is essential -- see our guide on AME vs. QME evaluations.
4. Arguing You Had Less Than Six Months Employment
If you are a newer employee, the insurer may argue the six-month rule bars your claim entirely. If your psych injury was caused by a sudden and extraordinary event (robbery, assault, explosion), the six-month rule does not apply -- but you need to clearly establish that the triggering event qualifies as sudden and extraordinary.
5. Using Your Statements Against You
Everything you say to the insurance adjuster, the claims examiner, and the evaluating psychiatrist can be used to undermine your claim. Offhand comments like "I've always been an anxious person" or "work is stressful for everyone" can be weaponized. For critical guidance on this, read what not to say to an insurance adjuster.
Getting a Proper Psychiatric Evaluation
The psychiatric evaluation is the most critical step in a psych claim. The evaluating psychiatrist's report will determine both whether your claim is accepted and how much it is worth. Here is what to expect and how to prepare.
Preparing for Your Psychiatric Evaluation
- Create a detailed timeline of workplace stressors, incidents, and how they affected your mental health. Include dates, witnesses, and any documentation (emails, complaints filed, incident reports).
- Be honest and thorough about your symptoms. Describe your worst days, not your best. Report sleep problems, appetite changes, concentration difficulties, withdrawal from activities, panic attacks, flashbacks, and any suicidal thoughts.
- Do not minimize personal stressors -- the evaluator will discover them anyway through records review. Instead, be prepared to explain why work was the primary driver of your condition despite any personal issues.
- Bring supporting documents: written complaints you filed, hostile emails from supervisors, photos of unsafe conditions, witness statements from coworkers.
- Expect a long evaluation. Psychiatric evaluations for workers' comp typically last 2-4 hours and include extensive questioning about your personal history, work history, symptoms, and daily functioning.
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Settlement Ranges for Psychological Injury Claims
Psych claim settlements vary widely based on the severity of the condition, whether it is a stand-alone claim or combined with a physical injury, and the strength of the causation evidence.
| Claim Type | Typical Settlement | Key Factors |
|---|---|---|
| Adjustment Disorder (Stand-Alone) | $15,000 - $35,000 | Lower PD rating (5-12%), often resolves with treatment, lower weekly rate |
| Major Depression (Stand-Alone) | $30,000 - $65,000 | Moderate PD rating (10-22%), may require ongoing medication, functional limitations |
| PTSD (Stand-Alone) | $40,000 - $100,000+ | Higher PD rating (15-30%+), often chronic, significant functional impairment |
| Psych as Consequence of Physical Injury | Adds $15,000 - $50,000 | Additional PD rating on top of physical injury, lower burden of proof, combined rating increases value |
| First Responder PTSD (Presumption) | $50,000 - $120,000+ | Presumption shifts burden to employer, higher acceptance rates, often combined with physical injuries |
Combining Physical and Psychological Claims
One of the most effective strategies for increasing total settlement value is combining a physical injury claim with a psychological component. When a serious work injury causes depression, anxiety, or PTSD, the psychiatric injury is treated as a "consequence" injury -- and the legal requirements are significantly easier to meet.
For consequence claims, you only need to show that the physical injury was a contributing cause of the psychiatric condition. There is no six-month employment rule, no predominant cause standard, and no good faith personnel action defense. This lower threshold means consequence psych claims are accepted at much higher rates than stand-alone claims.
The additional PD rating from the psychiatric component is combined with the physical injury PD rating using the Combined Values Chart. For example:
Example: Back Injury + Depression
Physical injury PD rating: 25% (lumbar spine surgery)
Psychological PD rating: 12% (major depression as consequence)
Combined PD rating: 34% (using Combined Values Chart, not simple addition)
Impact on settlement: The 9-point increase from 25% to 34% could add $20,000 to $35,000 in additional PD benefits. Under Labor Code §4660, higher PD percentages are worth exponentially more per point, making the combined claim substantially more valuable than either component alone.
First Responder Presumptions: A Stronger Path
California law provides special presumptions for law enforcement, firefighters, and certain other public safety employees who develop PTSD or other psychiatric conditions from their work. Under Labor Code Section 3212.15, if you are a qualifying first responder diagnosed with PTSD, the injury is presumed to be work-related.
This presumption is a game-changer. Instead of you having to prove that work was the predominant cause of your PTSD, the employer must prove that it was not. This burden-shifting makes first responder psych claims significantly more likely to be accepted and typically results in larger settlements.
Qualifying employees include peace officers, firefighters, emergency dispatchers, and certain other public safety personnel. The presumption applies to PTSD specifically -- other psychiatric conditions like depression or anxiety still face the standard predominant cause analysis, though they may still be compensable.
Overcoming Stigma and Fear
Perhaps the biggest obstacle to filing a psych claim is not legal -- it is personal. Many injured workers are reluctant to file psychological injury claims because of stigma, fear of being labeled "crazy," concern about career consequences, or worry that their claim will not be taken seriously.
Here is what you need to know:
- Psych injuries are real medical conditions. PTSD, major depression, and anxiety disorder are recognized diagnoses in the DSM-5-TR with clear diagnostic criteria. They are not signs of weakness.
- Filing a claim is protected by law. Under Labor Code §132a, your employer cannot retaliate against you for filing a workers' comp claim. Termination, demotion, or harassment because of your claim is illegal.
- Your medical records are confidential. Workers' comp medical records are not shared with your employer's HR department. The employer receives limited information about work restrictions, not the details of your psychiatric treatment.
- Untreated psych injuries get worse. Delaying treatment and avoiding filing a claim typically leads to worsening symptoms, reduced job performance, and eventually a crisis. Early intervention leads to better outcomes -- both medically and in claim value.
Tips for Strengthening Your Psych Claim
- Start treatment immediately. See a psychiatrist or psychologist as soon as possible. Consistent, documented treatment creates a medical record that supports your claim. Gaps in treatment are used by insurers to argue your condition is not as serious as claimed.
- Document everything at work. Keep a journal of workplace incidents, stressors, and their impact on your mental health. Save hostile emails, record the dates of verbal incidents (with witnesses), and file formal complaints through HR when appropriate.
- Be careful with social media. Insurers routinely monitor claimants' social media. Posting photos of yourself looking happy at a party or vacation can be used to argue your depression is not as severe as you claim. Adjust your privacy settings and be mindful of what you share.
- Do not accept "it's just stress." If your primary care doctor dismisses your symptoms as normal workplace stress, seek a psychiatric evaluation. Work-induced PTSD, major depression, and anxiety disorder are clinically distinct from ordinary job stress.
- Consider whether you also have a physical injury. If your psychological condition is related to a physical work injury, filing the physical claim first and adding the psych component as a consequence simplifies the legal requirements significantly.
- Hire an attorney before filing. Psych claims are complex and face aggressive opposition. An attorney experienced in psychiatric injury cases can help you prepare your evidence, guide you through the evaluation process, and counter the insurer's defenses.
For detailed information about psychological injury claims in California, visit our psychological injury workers' comp page. If you are also facing retaliation concerns, our employer retaliation guide covers your legal protections in detail.
Frequently Asked Questions
Can I file a workers' comp claim for work-related stress or anxiety?
Yes, but California imposes stricter requirements for psychiatric injury claims than for physical injuries. You must have worked for your employer for at least six months (unless the injury was caused by a sudden and extraordinary event like a workplace shooting or robbery), and you must prove that your actual employment conditions were the 'predominant cause' -- meaning at least 51% responsible -- for your psychiatric injury. These extra hurdles make legal representation especially important for psych claims.
How much are psychological injury workers' comp settlements worth?
Psychological injury settlements in California typically range from $25,000 to $100,000 or more. Stand-alone psych claims (without a physical injury component) tend to settle between $25,000 and $60,000. Combined physical and psychological claims -- where a serious work injury also causes depression, anxiety, or PTSD -- can push total settlement values well above $100,000 because the psychiatric component adds a separate PD rating on top of the physical injury rating.
What is the 'predominant cause' standard for psych claims?
Under Labor Code Section 3208.3, psychiatric injuries must be caused 'predominantly' (at least 51%) by actual events of employment. This is a higher standard than the 'contributing cause' standard used for physical injuries. The evaluating psychiatrist must determine whether your work conditions -- not personal stressors like divorce, financial problems, or family issues -- were the primary cause of your condition. If non-work stressors account for more than 49% of your psychiatric injury, the claim will be denied.
Do first responders have different rules for psych claims?
Yes. California provides special presumptions for certain first responders. Under Labor Code Section 3212.15, peace officers, firefighters, and certain other public safety employees who develop PTSD are presumed to have a work-related injury -- meaning the employer must disprove the work connection rather than the employee having to prove it. This presumption significantly strengthens first responder psych claims and often leads to higher acceptance rates and better settlements.
Can I be fired for filing a psychological injury claim?
No. Under Labor Code Section 132a, it is illegal for your employer to retaliate against you for filing any workers' comp claim, including a psychiatric injury claim. If your employer terminates you, demotes you, reduces your hours, or takes other adverse action because you filed a psych claim, you may have a separate retaliation claim worth additional penalties. However, the fear of retaliation is real and common -- an experienced attorney can help protect your rights throughout the process.
Get Confidential Help With Your Psych Claim
Psychological injury claims require specialized legal knowledge and careful preparation. Our free, confidential consultation evaluates your situation -- your workplace conditions, employment history, symptoms, and available evidence -- and gives you an honest assessment of whether your claim is viable and what it could be worth. We handle everything so you can focus on recovery.
Legal Disclaimer: This article provides general information about California workers' compensation psychological injury claims. It is not legal advice. Psych claims have unique legal requirements and high denial rates. Settlement values vary widely based on individual circumstances including your diagnosis, PD rating, employment history, and the strength of causation evidence. Contact our office for a free, confidential consultation about your specific situation.
David Lamonica (State Bar #165205) has handled numerous psychological injury claims, including stand-alone PTSD cases, first responder claims, and complex physical-mental combination cases. He understands the unique challenges of psych claims and works closely with psychiatric evaluators to build the strongest possible case for his clients.