What If the Insurance Company Simply Refuses to Provide Medical Treatment After Work Injury


My Work Injury Has Left Me With Mental Health Problems and the Workers Compensation Insurance Company Refuses to Provide any Counseling or Medicines! What Can I Do?

You can start by contacting the Law Offices of Marc Francis for assistance. At our Sonoma County workers’ comp lawyer office, we assist many severely injured workers who need mental health counseling, medicines, and disability benefits because their catastrophic physical injuries have left them in need of such benefits.

Years ago the state legislature restricted the availability of psychiatric and psychological benefits in cases where those problems arise from a physical injury, such as a fall from a roof or ladder, a motor vehicle accident, a construction injury, or other serious work injury. However, recent case law has provided clarification as to when psychiatric or psychological injuries that arise from a physical injury are compensable. The courts have ruled that the focus in making a compensability determination in such cases is on the nature of the physical injury itself, rather than solely on the mechanism of injury or the psychiatric response to the injury. In other words, the court has rejected the interpretation that the mechanism of injury itself (how the injury occurred) itself must be ‘catastrophic’ (such as an explosion, for example) and instead the court will now look at whether the impact on the injured worker or nature and extent of the medical problems suffered by the injured worker are ‘catastrophic’.

The court has identified certain factors to be considered by the Workers’ Compensation Appeals Board in determining whether the ‘catastrophic’ injury entitles the worker to psychiatric benefits. These factors have been generally identified as:

  1. Whether the physical injury is an incurable progressive disease;
  2. The intensity and seriousness of the treatment required by the injured worker to treat the physical injury;
  3. The nature and extent of the workers’ problems when becoming permanent and stationary;
  4. How the physical injury affects the injured worker’s ability to perform activities of daily living;
  5. Whether the physical injury is comparable to loss of a limb, paralysis, severe burn, or severe head injury (and these factors may include other types of injury as well).

It’s important to note that this analytical approach identified by the court is to be applied on a case-by-case basis; and that no two cases are exactly alike. But if you or a loved one is experiencing such problems, we recommend a free consultation with a Sonoma County workers’ comp lawyer at Law Office of Marc Francis. Call us today at (707) 664-9675 to discuss your case.

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