Georgia Employer’s routinely encounter workers’ compensation claims seeking lost-time benefits and/or medical treatment for alleged psychological injuries.
Georgia Employer’s routinely encounter workers’ compensation claims seeking lost-time benefits and/or medical treatment for alleged psychological injuries. While it is well established that a psychological injury must be preceded by or accompanied by a physical injury, the types of psychological injuries that are compensable and the evidence required to prove such injuries is far less clear.
The Georgia Court of Appeals recently revisited this issue in the case of DeKalb County Board of Education v. Singleton 294 Ga. App. 96; 668 S.E.2d 767 (2008). In Singleton, the claimant was employed by the county as a bus driver for special needs children. According to the record, her job duties resulted in exposure to heat, cold air, bus fumes, and cleaning material fumes and she occasionally wore a mask to minimize her exposure while in the bus yard. The claimant had a family history of asthma and was diagnosed with asthma in 2001. She had been fairly asymptomatic except that she had sought emergency treatment for asthma attacks three or four times prior to her job-related accident in August 2005.
On August 8, 2005, the claimant reported to work following the summer break. Upon finding her bus, she discovered that the interior was covered with a white power, which she believed was fire extinguisher residue and mold. She attempted to clean the bus following which she drove to her designated parking location approximately 35 to 40 minutes away. Shortly thereafter, she began to feel weak and drowsy. She was driven to the emergency room by her son where she was diagnosed with an asthma attack and given breathing treatment and medication. She was referred to a pulmonologist who opined that the August 8, 2005 incident aggravated her asthma. The employer subsequently sent the claimant to a panel physician who also felt her problems were the result of her exposure to fumes on her bus on August 8. A second panel physician later concurred with the diagnosis but indicated that the claimant was capable of returning to work without restrictions.
Approximately six months after her attack, the claimant was evaluated by a clinical psychologist and was diagnosed with adjustment disorder and depression and recommended for short term treatment. A second evaluation with a licensed psychologist and neuropsychologist, performed at the request of the employer/insurer, found that the claimant had “highly inconsistent symptoms that strongly suggest either a severe somatization disorder and/or malingering.” He also noted that the claimant “reported a moderately high level of depressive thoughts and feelings.”
At her hearing, the claimant testified that she did not feel safe driving the special needs children and that she feared her work environment would cause her asthma to get worse and result in another asthma attack. She did not believe she would survive another attack triggered by fumes and was also concerned that another attack could result in harm to the children.
The Administrative Law Judge (“ALJ”) found that the claimant sustained a compensable injury on August 8, 2005, in that a work-related inhalation injury aggravated her pre-existing asthma. He concluded that Singleton’s psychological conditions of depression, anxiety, and adjustment disorder were compensable injuries based on the fact that the asthma attack precipitated the physic trauma and that the employee’s difficulty in adjusting to the job accident resulted in symptoms of depression and anxiety. He therefore awarded income benefits, medical payments, and ongoing medical care. The decision was affirmed by the superior court.
On appeal, the employer/insurer argued that the superior court failed to apply the correct legal standard for determining whether a superadded psychic injury is compensable when there was no major psychic disability, the original physical injury quickly resolved, and there were no subsequent consistent complaints of any major psychic trauma.
Unfortunately, the court of appeals disagreed and affirmed the findings of the superior court. In doing so, they reviewed the current status of the law in Georgia with regard to the compensability of psychological injuries. Specifically, they found that in order for a psychological injury to be compensable it must satisfy two conditions: (1) it must arise out of an accident in which a compensable physical injury was sustained; and (2) while the physical injury need not be the precipitating cause of the psychological condition or problems, at a minimum, the physical injury must contribute to the continuation of the psychological trauma.
The court concluded that the claimant’s injuries were not “mild” but constituted a real fear of her own death from further asthma attacks and concern for the special needs children she would have been transporting. They also noted that there was at least some medical evidence to support the claimant’s contention that the psychic condition originated with her accident of August 8 and her physical injury contributed to the continuation of her condition.
In defending the case, the employer/insurer attempted to rely on the court’s decision in the in the 1983 case of ITT Continental Baking v. Comes, 165 Ga. App. 598; 302 S.E.2d 137. In that case, the employee suffered a compensable injury when three of the fingers of her left hand were severed. After receiving the maximum disability benefits to which she was entitled, she sought a change of condition based on pain from her original injury. The ALJ awarded renewed benefits for total disability based on a finding that the claimant had suffered a compensable “superadded injury” due to “mild depression and a great amount of anxiety” resulting from her work-related injury. The case eventually made its way to the Court of Appeals which, upon a review of the record, found that there was “no evidence that the claimant experienced any further disorder, mental or physical, as a result of her injury. Rather, the evidence show[ed] merely that her injury gave rise to ‘mild depression and a great deal of anxiety…’” The court went on to find that while such conditions may be debilitating, “neither can reasonably be characterized as a mental or nervous disorder. They are instead entirely natural, albeit unfortunate, responses to any type of severe physical injury.”
Cases such as Comes suggest that a psychological disability will more likely be compensable if it is diagnosed as a recognizable mental disorder. However, several cases have concluded that general anxiety and depression can constitute a compensable psychological injury when the symptoms are severe. See e.g., Howard v. Superior Contractors, 180 Ga. App. 68; 348 S.E.2d 536 (1986) (finding that post-traumatic stress syndrome manifested by depression and anxiety was an identifiable mental condition and thus compensable) and Atlas Automotive, Inc. v. Wilson, 225 Ga. App. 631; 484 S.E.2d 669 (1997) (finding that employee’s “major depressive disorder” began when he suffered a lumbar strain and continued to worsen).
The court in Singleton appears to distinguish their decision from the holding in Comes on the ground that Singleton’s psychological symptoms were not “mild.” Although not explicit in the opinion, the court also likely relied on the additional diagnosis of “adjustment disorder” and the possibility of “severe somatization disorder” in finding the claim compensable. It also appears that the ALJ found the claimant to be a very credible witness.
While cases such as Singleton and Comes give some guidance in determining the compensability of psychological injuries, the inquiry remains very fact-specific. If Singleton is any indication of current trends, an employer/insurer would be well-advised to seek out medical evidence minimizing the impact of the psychological injury, especially with regard to its severity and duration.