The West Virginia Supreme Court of Appeals on Wednesday upheld earlier rulings denying the addition of psychological conditions to an injured employee’s compensation claim.
The employee, a maintenance worker for M&G Polymers USA LLC, was injured when an engine fell from a buggy and trapped his leg in January 2015. The man sustained serious injuries and underwent two surgeries in the days that followed for a “serious fracture of the femur,” according to court documents.
The claim was found to be compensable for left femoral shaft fracture, left intertrochanteric femur fracture and left shoulder abrasions in January 2015, and later for shoulder and upper arm abrasions and friction burns. , hip crush injury, closed intertrochanteric femur fracture, closed femoral shaft fracture, left rotator cuff rupture, and impingement syndrome.
A September 2016 treatment note reported that the man suffered from depression and anxiety which began immediately after his work-related injury, indicating that he had suicidal thoughts, daily crying spells, obsessive thoughts and insomnia. A physician completed a diagnostic update requesting the addition of severe and recurrent major depressive disorder; post-traumatic stress disorder; and generalized anxiety disorder with the claim, which was dismissed by the claims administrator in November 2016.
In an earlier decision, the West Virginia Office of Workers’ Compensation Judges ruled that the three-step process for adding psychiatric disorders to a claim, as outlined in the case of Hale v. Office of the West Virginia Insurance Commissioner, were not tracked.
First, the applicant’s treating physician should refer the applicant to a psychiatrist for an initial assessment. Second, the psychiatrist must make a detailed report in accordance with the state code. Third, the claims administrator must determine whether the psychiatric condition should be added to the claim. The Judges’ Office noted that none of the measures set out in Vigorous were followed in this case, which the Supreme Court of Appeal confirmed.