Not a lot of exciting workers' compensation law or issues come out of Wyoming - one of the least densely populated states in the US.
But one case that came out of that state's Supreme Court highlights the difficult interaction of psychology/psychiatry and disability.
The real issue is who pays for it, and in this case the court said that the cost burden is on the work comp system.
In McMasters v. Wyoming, No. S-11-0107, 03/02/2012, Jimmie McMasters was working in 2003 as a heating, ventilation and air conditioning journeyman when he fell 9 feet from a beam to a concrete floor and suffered a compression fracture to his L1 vertebrae.
After five years of treatment and evaluation by numerous medical providers and specialists, McMasters applied for permanent total disability benefits claiming a total disability under the "odd lot" doctrine.
The "odd lot" doctrine, as recognized in Wyoming, provided that permanent total disability benefits may be awarded to workers who were "not altogether incapacitated for work" but were "so handicapped that they will not be employed regularly at any well-known branch of the labor market."
The doctors who treated McMasters diagnosed him as suffering from Agoraphobia, Panic Disorder, Pain Disorder and Major Depressive Disorder, which prevented him from accepting work which could accommodate his physical restrictions.
The Wyoming Workers' Safety and Compensation Division denied McMasters' application. Although the division determined that McMasters could not return to work as an HVAC journeyman, it concluded his failure to obtain alternative employment was due to a pre-existing psychological condition and a poor effort to find work. The Medical Commission agreed and upheld the denial of benefits.
Up the judicial ladder the case went and the Wyoming Supreme Court said that "(f)our separate professionals evaluated McMasters and concluded that the combination of his physical restrictions, pain and psychological condition has rendered him unemployable," and given this evidence, concluded "there can be no question that McMasters met his burden of showing that the degree of his physical impairment combined with his mental capacity, education, training, and age make him eligible for permanent total disability benefits."
While a worker must make a showing that he was unemployable in order to state a valid claim under the odd lot doctrine, the court explained he "is not required to show that he searched for work and could find none to prove he is permanently and totally disabled…"
Even if McMasters' psychological problems predated his work injury, the court added, "(t)he record (was) clear that it (was) the combination of the two conditions that has permanently and totally disabled McMasters."
Compare this case with one I recently highlighted in California where the 4th District Court of Appeals ruled that physical disability arising out of a mental disorder was not compensable - albeit in response to a California specific statute (Labor Code 3208.3) that imposed certain restrictions on mental injury claims.
The interesting aspect of the two cases is that there is judicial recognition that physical disability can have its origin in mental health.
This is important to a broader understanding of the interrelatedness of disability and mental health. There is a growing school of thought that in order to properly manage the disability you must first properly manage the psychology.
In a system like workers' compensation, however, properly managing the psychology means getting into an argument about responsibility (read liability) for what is likely a pre-existing, underlying condition.
At the end of the day, someone pays for it. The cost may not be borne by the employer directly, but certainly the cost is borne by society, which means that the cost is spread to all of us.