Printed from

Psych expansion of physical injury claim denied

Posted On: Sep. 24, 2021 1:51 PM CST


The West Virginia Supreme Court of Appeals on Wednesday upheld prior rulings denying psychological conditions be added to an injured employee’s workers compensation claim.

The employee, a maintenance worker for M & G Polymers USA LLC, was injured when a motor fell from a buggy and pinned his leg in January 2015. The man suffered extensive injuries and underwent two surgeries in the days that followed for a “severe segmental femur fracture,” according to court documents.

The claim was held compensable for left femur shaft fracture, left intertrochanteric femur fracture, and left shoulder abrasions in January 2015, and later for shoulder and upper arm abrasions and friction burn, hip crushing injury, closed intertrochanteric femur fracture, closed femur shaft fracture, left rotator cuff tear and impingement syndrome.

A September 2016 treatment note reported the man experienced depression and anxiety that began immediately after his work-related injury, stating he had suicidal thoughts, daily crying spells, obsessive thoughts and insomnia. A doctor completed a Diagnosis Update requesting the addition of severe, recurrent major depressive disorder; post-traumatic stress disorder; and generalized anxiety disorder to the claim, which was denied by the claims administrator in November 2016.

In a prior ruling, the West Virginia Workers Compensation Office of Judges ruled that the three-step process for adding psychiatric conditions to a claim, as outlined in the case of Hale v. West Virginia Office of the Insurance Commissioner, were not followed.

First, the claimant’s treating physician must refer the claimant to a psychiatrist for an initial evaluation. Second, the psychiatrist must make a detailed report consistent with state code. Third, the claims administrator must determine whether the psychiatric condition should be added to the claim. The Office of Judges found that none of the steps set forth in Hale were followed in this case, which the Supreme Court of Appeals upheld.