by Lenin V. Perez
Stress related disabilities are compensable under the Federal Employees’ Compensation Act (FECA). They generally fall into three categories: mental stimulus causing a physical injury (such as a heart attack); physical injury causing a mental condition (such an anxiety disorder); or a mental stimulus causing a mental condition (such as major depressive disorder). Aggravation of a pre-existing condition is covered under the act. The claimed condition may arise from a sudden event (such as witnessing violence in the workplace) or from long-term exposure to workplace stress (such as harassment).
To be covered under FECA, an emotional reaction must have been caused by factors of employment arising out of regular or assigned work duties, or out of a requirement imposed by the employment. However, not all claims based on emotional reactions having some connection to the workplace are compensable under FECA.
To be covered, the employee must meet three criteria:
- Work factors claimed to have caused the reaction must be shown to have actually occurred. Supporting documentation or witness statements must be submitted.
- Work factors claimed to have caused the reaction must arise from the employee’s regular or specially assigned work duties, or from a requirement imposed by the employment. Administrative or personnel actions, performance ratings and assessments, discussions of performance, actions relating to sick leave or annual leave are not work factors for purposes of a claim unless it is shown that the agency acted erroneously or abusively.
- If the previous two criteria are met, medical evidence must be submitted. This evidence must be solely based on the claimed work factors and must contain a clear and unequivocal medical rationale showing that the claimed emotional reaction is causally related to the work factors.
To satisfy the third requirement above, the employee must prepare a written statement of the work factors which the employee claims caused the reaction. This statement must be presented to the employee’s attending physician who must then write a medical report using the employee’s statement as a frame of reference that includes all of the following items:
- The physician’s assertion that he or she has read the employee statement and is exclusively using the work factors described in the statement as a basis for his or her medical discussion and opinion.
- A definitive diagnosis stated in definite and clear language (speculative language such as “might have caused the condition” is not sufficient).
- A definitive statement that the claimed condition that has been diagnosed was caused, aggravated, accelerated or precipitated by the work factors in the employee’s statement; and whether such resultant condition is temporary or permanent.
- The physician must provide medical reasons for his or her opinion that the work factors caused the condition diagnosed. The medical relationship between the diagnosis and the work factors must be outlined in positive, definitive language, and any tests results must be included to support the relationship. This is most often included in the Physician’s Comment or Summary section of the medical report.
- The extent of the disability must be described (whether the disability is total or partial); and if the disability is partial, the work limitations must be outlined for the employee while working during the time of disability. The period of time the claimant will be partially or totally disabled must be defined. This is most likely indicated by the GAF (Global Assessment of Functioning) in the physician’s diagnosis.
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Federal Workers Compensation Consultants
Workers Compensation and Disability Retirement Specialists
9639 N. Armenia Avenue
Tampa, Florida 33612
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