Hale v. Office of Ins. Comm’r Discusses Psychiatric Injuries in North Carolina Workers’ Compensation Claims

Work related injuries can affect you not only physically but mentally and emotionally. If you have been involved in a work related injury in North Carolina, get the advice of an experienced North Carolina injury attorney to help you get the benefits you deserve. Attorney Henry Teich has been a North Carolina Board Certified Specialist in Workers’ Compensation Law for more than 10 years.

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Hale v. Office of Ins. Comm’r is a case that shows how challenging some Worker’s Compensation (“WC”) claims for psychiatric injuries can be.

Hale (“Plaintiff” or “Claimant”) was the employee of the Office of Insurance Commissioner in West Virginia (“Defendant”). While working for this office, Hale sustained injuries to his back. As a result of these injuries, Hale received a permanent partial disability award.

Claimant later sought a psychiatric evaluation. The doctor evaluating claimant identified that the claimant was suffering from panic disorder and major depressive episode created by the work accident where he injured his back. These reports were submitted by this doctor in the attempt to add depression as a compensable injury to claimant’s WC claim.

The Worker’s Compensation Board of Review (“BOR”) and the WC Office of the Judge (“OOJ”) rejected claimant’s proposed amendment. The main contention was that the claimant was required to seek approval from his WC claims administrator before he sought the psychiatric evaluation. Claimant then appealed this decision to the state supreme court.

The question presented to the court was whether a claimant in a workers’ compensation claim must get prior authorization from the WC administrator before claimant gets a psychiatric consultation. The court begins with a summation of the basic WC rules which are:
– In order to for an injury to be considered compensable for WC purposes there must be a personal injury, this injury must have been sustained during the course of employment and the injury must be a result of employment.
– In a WC case, the claimant has the burden of proving the claim.
– In West Virginia, a psychiatric disability is compensable for purposes of WC when the injury arose out of comprehensible physical injury.

The court was charged with interpreting two state WC statutes that conflicted with each other. In order to establish whether the rules and procedures created by an administrative agency will be upheld, the rule or procedure must be reasonable and cannot “enlarge, amend or repeal substantive rights created by statute.” See State ex rel. Callaghan v. W.Wa. Civil Serv. Comm’n, 273 S.E.2d 72 (1980).

Within one of the statutes, the claims administrator would be charged with making a decision regarding psychiatric treatment without the expert medical or psychiatric opinions. This West Virgina court found that this restriction on claimant’s psychiatric treatment was not reasonable and it was inconsistent with the intent of the statute drafters. WC was created to provide compensation to workers who are injured in the course of their employment. Therefore, the state Supreme Court held that this type of requirement would be an invalid exercise of administrative regulation.

The court here upheld the other statute and cited previous case law that established a threefold process to determine whether a claimant can add a psychiatric disorder as a compensable injury in a WC claim. In order for a claimant to add a psychiatric disorder to the claim, claimant’s treating physician must refer the claimant to a psychiatrist for a consultation. Upon completing this initial consultation the psychiatrist is required to provide a detailed report consistent with WC law. Lastly, the claim administrator is responsible for utilizing the psychiatrist report and determining whether the psychiatric condition should be classified as a compensable injury in the claim.

Being silent about your mental health is not necessary in WC claims. This case shows how important it is to understand your rights.

If you have been injured, contact our North Carolina and South Carolina injury attorneys to discuss your case free of charge. Call 1-800-533-6845.

Additional Resources:
Hale v. West Virginia Office of Insurance Commissioner, No. 101028 (W.Va. Mar. 22, 2012).

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