Compensability of Mental Impairment

Administrative Law Judge (ALJ) denied compensability of claimant’s claim and request for temporary disability and medical benefits. The Industrial Claims Appeals Office (the Panel) reversed the decision and remanded the case for the ALJ to consider issues involving medical benefits and timely reporting of an injury.

In Montoya, claimant worked as a sheriff’s deputy until August, 2018. He alleged he suffered from post-traumatic stress disorder (PTSD) from his work in law enforcement. Notably, the mental impairment statute was amended effective July 1, 2018, to include PTSD when caused by an event within a worker’s usual experience. Prior to the amendment, a mental impairment was compensable if a psychologically traumatic event arouse out of and in the course of employment when the accidental injury consisted of a psychologically traumatic event that is generally outside of a worker’s usual experience. The ALJ ruled that claimant’s PTSD arose prior to July 1, 2018, and so his mental impairment was not compensable as it did not fall outside of claimant’s usual experience as a sheriff deputy.

On appeal, claimant argued in his petition to review that the ALJ’s findings of fact did not support the order. Upon review, the Panel determined the ALJ had denied the claim based on two pieces of analysis. First, the ALJ determined that the date of onset of claimant’s occupational disease arose prior to July 1, 2018. Second, the ALJ applied the statute as it had existed prior to the amendment to conclude claimant’s PTSD did not qualify as a compensable mental impairment injury.

The Panel held that the conclusions of law regarding the date of onset were not supported by the findings of fact. While the ALJ found that claimant’s condition was interfering with his ability to perform his job prior to July 1, 2018, the Panel ruled that the pertinent date for determining the onset of claimant’s occupational disease was August 20, 2018, when claimant was officially declared unfit for duty. The Panel held that August 20, 2018 was the appropriate date because the mental impairment statute requires “that the mental impairment be, in and of itself, sufficient to render the employee disabled ‘from pursuing the occupation from which the claim arose.’” Thus, because the date of claimant’s occupational disease occurred after the July 1, 2018 amendment, the Panel held that claimant sustained a compensable occupational disease that arose out of the usual experience of being a patrol deputy. Accordingly, the Panel reversed the ALJ’s Order and set aside the ALJ’s denial of claimant’s entitlement to temporary disability benefits.

Montoya v. Fremont County Sheriffs Office, W.C. NO. 5-084-877-001 (ICAO Oct. 16, 2019)

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From the December 2019 Newsletter