Peterson v. City of Minneapolis
The employee, a police officer, claimed he sustained a work-related injury in the nature of post-traumatic stress disorder (PTSD). Because he was a police officer, he was entitled to the statutory presumption his PTSD was work-related. Consequently, he would be entitled to workers’ compensation benefits unless it rebutted this presumption. The City of Minneapolis denied Peterson’s PTSD claim, in part, on the basis that he had a mental health condition that predated his employment with the City.
The employee underwent an Independent Medical Evaluation (IME), following which the IME acknowledged the employee had PTSD in the past. Interestingly, the employee’s expert agreed that due to the treatment Peterson received, he no longer satisfied these criteria. Instead, she diagnosed him as suffering from other specified trauma disorder as a consequence of the PTSD. Later, after reviewing the latest version of the DSM, the employee’s expert updated her opinion, stating the new criteria mandates that if you have PTSD persisting for more than a month, you have a lifetime of PTSD. The judge adopted this opinion. Significantly, the judge also awarded a 30% penalty for a frivolous denial.
On appeal, the WCCA remanded to have the judge find whether the employee had a consequential mental health injury. The judge found that he did. The City of Minneapolis appealed this finding. The case eventually made its way to the Minnesota Supreme Court.
The Minnesota Supreme Court affirmed in part and reversed in part. The Court held that judges are free to adopt the opinion of one medical expert over another. Therefore, it did not change the finding that Peterson has PTSD even if he no longer met all of the criteria needed for an initial PTSD diagnosis. Because the judge accepted the IME’s view that the employee had present PTSD, the issue of a consequential psychological condition was rendered moot.
Finally, the Court upheld the 30% penalty. The Court acknowledged that while it may be difficult for insurers to gather prior medical records within the 14-day investigation period, that is a legislative issue. The judge acted within his discretion in awarding the penalty.
Final Takeaway: We believe Peterson will have two main impacts on PTSD cases. First, we believe that the compensation judge who decides the case will be significant in the ultimate outcome of this case. We foresee some judges accepting what are, essentially, sub-threshold PTSD diagnoses while others will not accept those diagnoses. The question of whether a lifetime PTSD diagnosis or a consequential other trauma disorder claim is compensable is not yet clear. More importantly, Peterson stands for the proposition that if an employer or insurer is going to deny a claim, the denial must be based on accurate, fact specific reasons. Generic denials or those that misstate the material facts of the case might result in exposure for penalties. It will be very difficult to deny PTSD claims, especially in light of the difficulty you will encounter in obtaining an expert opinion in a timely manner. Please reach out to one of our attorneys if you would like our help in drafting denial language.
