California Psyche Claim Reference Guide

Published May 28th, 2025

Unlike claims involving bodily injury, continuous trauma and occupational disease, assertions of a psychiatric injury have separate established criteria in establishing AOE/COE. Labor Code Section § 3208.3 provides the criteria for an Examiner to analyze when in receipt of the assertion of a work-related psychiatric injury. The reference guide below provides each element of this code section with an explanation of how it applies when evaluating AOE/COE.

The onus is on the injured worker to prove they sustain a work-related psychiatric injury. However, this does not absolve the Examiner from conducting a “Good Faith Investigation” per Regulation § 10109. An investigation into the facts is essential in determining AOE/COE considering a claim of psychiatric injury.

Must Cause Disability or Need for Medical Treatment and Diagnosed

Just like with other types of injuries, an assertion of a psychiatric claim must cause disability or the need for medical care. Further, the psychiatric claim must be diagnosable.

Labor Code Section 3208.3(a) states that a psychological injury SHALL be compensable if it:

·         causes disability or need for medical care;

·         is diagnosed by a physician defined by the labor code, and

·         the diagnosis using the terminology and criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, or of other manuals generally approved and accepted nationally by practitioners in the field of psychiatric medicine.

Employment was the Predominate Cause or 51%

For the employee to have a work-related psychological injury, the employee shall demonstrate by a preponderance of the evidence that actual events of employment were predominant (51%) as to all causes combined of the psychiatric injury. This is determined by a physician after reviewing all the facts presented. The physician could leave this determination up to “the trier of fact.” This means that ultimately a Judge could decide regarding predominate cause. It is important to conduct a thorough investigation to ascertain all elements that could cause a psychiatric injury absent the employment. For example, is the employee going through a divorce, bankruptcy, etc. Elements that by themselves could result in an injury.

Victim or Exposed to a Violent Event, Substantial Cause, 35% to 40%

In the event the employee is a victim or exposed to a significant violent act, the employee shall be required to demonstrate by a preponderance of the evidence that actual events of the employment were a substantial cause of the injury. Substantial cause means 35% to 40% of the causation from all sources combined.

 Six Month Rule

The employee must be employed with the employer for six months to be compensated for a psychiatric injury. The six months does not need to be a continuous period.

An exception exists in which compensation could be provided if the psychiatric injury is the result of a sudden and extraordinary event on the job.

Sudden & Extraordinary Events

This is defined as an event that is uncommon, unusual, and unexpected. There are many published decisions that have a common theme. Several of them deal with roofers, farm workers and others that commonly work at heights. The courts have come to a similar conclusion that it is not uncommon, unusual, or unexpected for a worker in this role to fall from a roof and/or ladder. Therefore, benefits for these employees were denied as they were employed for less than six months and could not establish whether their injuries were sudden and extraordinary in nature.

A violent act could be construed as a sudden and extraordinary event as this is uncommon, unusual and unexpected.

Psychiatric Claims Asserted Post Termination

The employee may file a claim for psychiatric injury after receiving notice they are being terminated. This includes layoffs and voluntary layoffs. This deals with the assertion on the part of the employee of an injury being sustained prior to receiving notice of termination.     

For an employee to receive compensation for an injury sustained prior to termination but claimed after termination, one or more of the following conditions must be met:

·         Actual events of employment were the predominant cause of the psychiatric injury (51%) as to all causes combined.

·         The injury was caused by sudden and extraordinary events at the job.

·         The employer had notice of the psychiatric injury prior to notice of termination.

·         The employee has medical records that show treatment for the psychiatric injury prior to the notice of termination.

·         A finding of sexual or racial harassment by any trier of fact, whether contractual, administrative, regulatory, or judicial.

·         Evidence that the date of injury is after the date of notice of termination, but prior to the effective date of the termination.        

 Lawful Nondiscriminatory Good Faith Personnel Actions

The employee may not secure compensation for a psychological injury resulting in lawful nondiscriminatory good faith personal action. Examples usually include the employee experiencing stress and anxiety because of performance discussions linked to poor performance. The burden of proof is on the individual asserting the issue. Whether the personal action was in good faith also could be up to “the trier of fact.”

Conclusion

When faced with the claim of a work-related psychiatric injury the criteria set forth in Labor Code Section § 3208.3 provide valuable tools in guiding the investigation and ultimate compensability decision. Each case deserves a good faith investigation into the facts; however, psychiatric cases require a deep dive into all circumstances, work-related and otherwise in establishing how the injury, diagnosis and disability occurred.

Alta Claims Institute provides training to the workers’ compensation industry. Learn more by visiting our website altaclaimsinstitute.com.