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The Pennsylvania Supreme Court has made it clear — whether you call the workers’ compensation claim mental/mental or mental/physical, the burden of proof is the same. “We hold that where a psychic injury is claimed, regardless of whether it is manifested through psychic symptoms alone or physical symptoms as well, the claimant must establish that the injury arose from abnormal working conditions in order to recover benefits,” Justice Stephen Zappala wrote for the six-justice majority. Justice Russell Nigro filed the lone dissent in the case, stating that the majority incorrectly relabeled a physical injury as a psychological injury with “physical manifestations.” “I find the majority’s characterization, throughout its opinion, of a physical illness arising from a psychological stimulus as merely the ‘physical manifestation of psychic injury’ to be so restrictive as to make recovery pursuant to the mental/physical paradigm nearly impossible under any circumstances,” Nigro wrote. “Based on the majority’s present analysis, it in effect has eliminated the mental/physical paradigm.” There are three cause-and-effect paradigms for workers’ compensation claims: physical/mental (physical stimulus causing psychological injury); mental/mental (psychological stimulus causing psychological injury); and mental/physical (psychological stimulus causing physical injury). Traditionally, mental/mental cases have been the most difficult to prove, because they require a showing that the claimant worked under abnormal conditions. Thus, a number of claimants with psychological injuries started to argue their cases under the far easier to prove physical/mental or mental/physical standards. Without any guidance from the Supreme Court, the state’s Commonwealth Court has been applying the easier-to-prove standard enunciated in Whiteside v. Workers’ Compensation Appeal Board (Unysis). In Whiteside, the intermediate appeals court held a plaintiff alleging a mental/physical claim had to show distinct identifiable physical injuries and to present unequivocal medical testimony that causally connects the physical injury to the workplace. The high court denied allocatur in that case. But now the justices in Davis v. Workers’ Compensation Appeal Board (Swarthmore Borough) have reversed the Commonwealth Court and set the record straight. Whenever the nature of the claim is psychological, even if it has physical symptoms, the claimant will have to prove abnormal working conditions caused the injury to recover benefits. POLICE WORK In 1992, James Davis filed a claim petition under the Workers’ Compensation Act alleging that as a result of repeated stressful and life-threatening experiences during the course of his duties as a police officer, he suffered from post-traumatic stress disorder and specific work inhibition. Dr. Sol Kadish testified that the accumulation of events experienced by Davis from 1965 to 1991 was the cause of Davis’ psychic injury. As to “physical manifestations” of Davis’ psychic injury, Kadish said that Davis has shortness of breath, feels pressure on his chest, becomes nervous, and has generalized muscle twitching with aches and pains. He has flashbacks and reliving experiences of these various stressors, the doctor testified, and “most significantly, his right hand shakes.” At his deposition Kadish testified that there was a direct temporal connection between the onset of Davis’ hand tremors and an event that occurred while at work as a police officer. The workers’ compensation judge awarded benefits to Davis, finding that he suffered and continues to suffer from a “bona-fide psychiatric illness.” The Workers’ Compensation Appeal Board reversed the WCJ’s decision. Davis’ claim was categorized by the board as a mental/mental claim, and the board determined that Davis failed to establish that abnormal working conditions had caused his psychic injury. Davis’ working conditions were not unusually stressful for police work, the board concluded. On appeal, the Commonwealth Court reversed the board’s decision, concluding that Davis did not have to establish that his injury was caused by abnormal working conditions. “The court reasoned that because Davis had introduced evidence that he was exposed to a psychological stress that caused him to suffer a distinct physical injury, i.e. right hand tremor, Davis was not required to prove abnormal working conditions,” according to the Supreme Court opinion. “The court held that Davis was required to prove only that the psychological stress of normal working conditions caused a physical injury, stating that ‘he is not saddled with the heightened burden of proving an abnormal working condition.’” The Supreme Court granted allocatur to address “the confusion engendered by the Commonwealth Court’s application of a different burden of proof in cases where a claimant seeks benefits for psychic injury, asserting that the psychic injury is manifested through physical symptoms.” THE ‘MARTIN’ STANDARD Under the 1990 Supreme Court case Martin v. Ketchum Inc., “To recover workers’ compensation benefits for a psychic injury, a claimant must prove by objective evidence that he has suffered a psychic injury and that such injury is other than a subjective reaction to normal working conditions,” the court said. “Even if a claimant shows actual, not merely perceived or imagined, employment events that have precipitated psychic injury, the claimant must still prove the events to be abnormal in order to recover.” Davis claimed his case was not controlled by Martin because he suffered not only from a psychic reaction to his working conditions, but also a physical reaction. But the court rejected that claim, stating it has traditionally applied the Martin standard “in cases where the claimant suffered a psychic injury that was manifested through both psychic and physical symptoms.” “We conclude that it is the nature of the injury asserted, not the presence or absence of physical symptoms, that is controlling,” Zappala said. “Accordingly, we hold that the standard to be applied to claims for workers’ compensation benefits when the claimant asserts a psychic injury that has manifested itself through psychic and physical symptoms is the same standard that we articulated in Martin such a claimant must prove by objective evidence that he has suffered from a psychic injury and that the psychic injury is other than a subjective reaction to normal working conditions.” Applying this standard to Davis’ claim, the court concluded that the evidence did not establish that the claimant’s post-traumatic stress disorder and related physical complaints were caused by abnormal working conditions. “There was absolutely no evidence that the investigatory and patrol functions performed by Davis or his experiences were unusual for a law enforcement officer.” DISSENT In his dissent, Nigro said he disagreed that a claimant who sustains physical injuries from a psychological stimulus must prove an abnormal working condition to recover benefits. “I contend that, merely because the cause … of certain physical ailments may have a psychological component, the physical injury … is not metamorphosed into a psychological injury with physical manifestations and the subsequent burden of proof is not the two-pronged Martin test,” Nigro said. “Instead, where, as here, a physical injury results from a psychological stimulus, the proper burden of proof is that articulated for a mental/physical claim under Whiteside“ Nigro said that, based on the findings of the WCJ and the Commonwealth Court, “the instant case is properly characterized as mental/physical.” Therefore, the two-prong test enunciated in Martin does not apply, he said. “Instead, the facts and holding of Whiteside are on point,” he said. Nigro said that he would find that Davis met his burden under Whiteside and should receive benefits for his physical disability.

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