Compensability for occupational diseases has becomecommonplace in most, if not all, jurisdictions throughout the country; however, the majority of claims filed allege physical rather than mental disability. The California Workers' Compensation Institute recently published their study of mental stress claims which indicated an increase of 430 percent in the number of claims filed from 1980 to 1986.
The main causes for these claims include job pressures, harassment, and job termination. Other types of discrimination and stressors account for a small percentage of the claims filed. (See charts entitled "Mental Stress Claims--Causes" and "Mental Stress Claims-The Growing Trend." CWCI Research Notes, April 1988.)
The age of the worker also appears as a significant variable in determining whether a claim for mental stress is filed. In general, younger workers are more likely to file such claims than older workers. Almost 60% of the claims reported by the National Council on Compensation Insurance were filed by workers under the age of 40. (A complete breakdown is shown in the chart entitled _"Mental Stress Claims--Age of Worker." National Council on Compensation Insurance, 1985.) It is possible that the stigma associated with mental or emotional illness has been reduced, thus enabling workers who are experiencing these conditions to file claims; whereas their older counterparts have preferred to keep their emotional problems out of the public eye. Another possible explanation for the increased filing of mental stress claims in general may be the faster-paced world in which we now live and the increased pressures on families where both spouses must work.
For many years, employment situations have led to stressful conditions for employees. An employee may be faced with stress generated by the immediate performance of the task itself or by collateral problems associated with the work environment. The decade of the 1980's has brought with it an increased awareness of and sensitivity to the sociological and environmental aspects of the workplace. New attention has been focused upon such areas as sexual harassment, the dangers of co-workers' smoking in the workplace, and the threat of communicable diseases such as AIDS.
Mental disease has been a challenge to the workers' compensation system since its inception. The complexity of the causal relationship of psychological, emotional, and nervous disorders to a work environment and the subjective analysis of various mental disorders have been a challenge to the objective standards of the workers' compensation system, the underlying basis of which is to provide benefits to disabled workers through social remedial legislation.
Mental stress claims are generally divided into 3 classifications: 1. Claims in which physical injury results in mental disability; 2. Claims in which mental stress results in physical disability; 3. Claims in which mental stress results in mental disability.
Physical Injury-Mental Disability
Disabilities caused by traumatic events which result in mental disability have been afforded compensation under the New Jersey Act. Both psychoneurosis and conversion hysteria flowing from industrial accidents have been deemed compensable. In Watts v. City of Newark, 25 N.J. Misc. 402 (Com.Pl. 1947), the court concluded that a hysteria may be the cause of a disabling condition in the absence of any discernible and anatomical cause.
Indeed, it was the absence of apparent connection between the objective, discernible, tangible event and the neurotic symptoms which caused the condition to be termed "an hysteria." In this case, since even the physicians appearing for the respondent were unwilling to term the claimant a malingerer, the petitioner was awarded 100% total disability as a result of severe psychoneurosis and conversion hysteria.
In another situation, an employee who suffered a serious back injury with permanent physical impairment also suffered mental consequences which resulted in permanent psychiatric disability. Psychiatric experts on both sides independently _concluded that the worker was suffering from a state of mind that constituted a mental disorder. Their determination was based upon sound professional medical judgment, thereby constituting objective medical evidence of the employee's psychiatric disability under the Act. Margaritondo v. Stauffer Chemical Company, 217 N.J.Super. 560 (App.Div. 1985), remanded by 104 N.J. 388 (1986), aff'd on rehearing 217 N.J.Super. 565 (App.Div. 1986).
Mental Stress-Physical Disability
In instances where mental stress results in either a traumatic event or disability which is physical in nature, the courts have continued to award compensation benefits. In Hall v. Doremus, 114 N.J.L. 47 (1934), an individual who was employed as a laborer on a farm, who was unloading a wagon containing hay, and who was stunned when he discovered a cow giving birth, suffered a "terrifying ordeal" and was permitted to receive workers' compensation benefits for a fractured skull which he sustained as a result of his fainting and falling to a concrete floor.
In a more recent case, an office worker who was hired as a bookkeeper was permitted to recover compensation benefits for a coronary infarction which was said to have been caused by her failure to balance her books. The court took into consideration her pre-existing hypertension but nevertheless concluded that the incident was a work-related event. The court decided that it was more probable that a person of the employee's age, emotional fears, and pre-existing hypertension would suffer such stress as _a result of her concern for her failure to provide a correct accounting and that this would be sufficient to precipitate or accelerate the resulting coronary infarction. Coleman v. Andrew Jergens Company, 65 N.J.Super. 592 (Law Div. 1961).
The courts have recognized that physical stress and strain can result in physical injury; the courts have also concluded that continued emotional stress to which an employee may be subjected may be considered to be a factor in the causation, exacerbation, or acceleration of the progression of physical conditions such as artherosclerotic disease. In interpreting the phrase "substantial condition, event, or happening" as promulgated in N.J.S.A. 34:15-7.2, the court determined that the employee's activities should be measured against the "wear and tear of the claimant's daily living." Therefore, the level of a claimant's emotional stress can also be recognized as a standard against which a particular event can be measured. Hellwig v. J.F. Rast & Company, Inc., 110 N.J. 37 (1988).
Mental Stress-Mental Disability
Jurisdictions throughout the United States have had divergent opinions with regard to the recognition of psychiatric disability flowing from mental disorders. Two major schools of thought exist with regard to this area of law. The Michigan approach is that an injury caused by gradual mental stimuli is considered compensable. An assembly line worker who suffered from paranoid schizophrenia was awarded benefits. In this case, the award was based upon the employee's purely subjective _reactions to the work which in turn were based upon his own perception of his inability to maintain the production rate of the assembly line. Carter v. General Motor Corporation, 361 Mich. 577 (Mich. 1960). The ruling was extended to another factual situation in which, as a result of being a compulsive perfectionist, an employee became irritable and nervous about the poor working habits of his co-worker. The perfectionist's abnormal perception of his employment was considered not to have diminished the causal nexus, and compensation was awarded for the resulting psychoneurosis since the disturbance that the individual experienced was not imaginary to him. MacKenzie v. General Motors Corporation, 403 Mich. 1 (Mich. 1978).
On the other end of the spectrum of the jurisdictional split is Wisconsin's so-called "objective" approach, where "out of the ordinary stress is required." The test for compensability for mental disease flowing from mental stress is that there be a situation which would exist which is greater than the dimensions of normal day to day stress and tensions which employees experience. In one particular claim, a schizophrenic suffered a mental breakdown which was alleged to have occurred as a result of pressure caused by seasonal business and harassment by her supervisor. The work stress experienced by the employee was considered by the petitioner's medical expert to be the principal cause and major factor in her mental breakdown, and benefits were awarded. Swiss Colony v. Department of ILHR, 72 Wis.2d 46 (Wis. 1976).
California adopted a more moderate approach in the early 1970's holding compensable those matters where gradual mental stress occurred in the ordinary pursuit of daily employment activity and resulted in mental disability. In Baker v. Workmen's Compensation Appeals Board, 18 Cal.App.3d 852, (Cal. Ct. App. 1971) a full time fire fighter was exposed to fumes and smoke while battling a blaze in 1953. Over the years he continued to be exposed to acrid fumes and smoke, and he continued to complain of physical disability although objective findings were absent. His condition became progressively worse, and in 1968 he was unable to work and was declared to be totally and permanently disabled. Evidence was presented that the claimant was preoccupied with heart disease as a result of stressful experiences and fatigue and some probable lung damage. The court indicated that the fire fighter suffered from a psychoneurotic syndrome which it described as "cardiac neurosis." It attributed this mental disability to the claimant's work environment and to the cumulative effect of the daily stress and strain of his employment.
In a generally imperfect world which subjects employees to stress and anxiety from many aspects of daily living, California further defined its approach to permit compensability where the employment is merely one of the contributing causes which would be determined to be proximate to the resulting mental disability. A cake baker who had a series of conflicts with her supervisor concerning scheduling of work hours and a temporary layoff and who was said to have had an honest misperception of job harassment was awarded compensation benefits even though she had suffered stress from pre-existing conditions including marriage to a brutal (first) husband and a childhood traumatized by parental divorce. Albertson's Inc. v. Workers' Compensation Appeals Board, 131 Cal.App.3d 308 (Cal. Ct. App. 1982).
New Jersey has followed a consistent middle of the road approach and has permitted the awarding of compensation benefits for mental injuries where no physical disability is evident. A steam engineer who sustained no physical injuries but who suffered from a complete psychoneurotic disability as a result of the explosion of a steampipe in a boiler room was permitted to recover disability benefits. Evidence presented demonstrated that the employee's state of comparative health changed dramatically as a result of the psychic trauma. Simon v. R.H.H. Steel Laundry, Inc., 25 N.J.Super. 50 (1953), aff'd 26 N.J.Super. 598 (N.J. 1953).
New Jersey requires that a disability be established, that the disability arise out of the employment and that the petitioner carry the burden of proof through the use of objective evidence. An individual who was labelled an "idiot" by a co-worker, who suffered a "nervous spell" and who was taken by her father for one visit to a treating physician for a "nervous spell" was denied benefits for her failure to establish disability under the Act. Voss v. Prudential Insurance Company, 14 N.J.Misc. 791 (N.J. Dept. of Labor 1936).
Additionally, a New Jersey assembly line worker in a case similar to the factual situation in Carter, supra, was denied benefits for a disability -based upon repetitive mental strain. In interpreting the decision based on the law prior to the 1979 amendments to the Workers' Compensation Act, the court recognized the longstanding Ciuba doctrine, which eliminated the need to show unusual strain or exertion, Ciuba v. Irvington Varnish & Insulator Co., 27 N.J. 127 (N.J. 1958), but denied compensability based upon a lack of evidence demonstrating that the mental disability "arose out of the employment." While rejecting the totally subjective course followed by Michigan, the courts in New Jersey appear to have adopted an approach which requires an objective evidential basis demonstrating that a mental disability arose out of an employment and was due in some "realistic sense of material degree to a risk reasonably incident to the employment." The New Jersey system will not rely upon the purely subjective reaction of the employee and his perception of his work demands. The court will not rely solely upon the petitioner's unrealistic perception of the work since it considers such an evaluation to be made by a "diseased mind." The court has indicated that testimony by co-workers with regard to the conditions of the employment as well as testimony by medical experts to support causal relationship will be required to support a claim. Williams v. Western Electric Company, 178 N.J. Super. 571 (N.J.App.Div. 1981).
In summary, the courts in New Jersey permit the awarding of workers' compensation benefits in those instances where psychological disability can be shown to have arisen out of the employment and can be substantiated by objective medical evidence. Where a mental disability can be considered occupational rather than traumatic in origin, the time frame for instituting a claim for benefits would be based upon when the disease is recognized as causally related to the employment, as it would be with any other occupational disease claim. As the condition of mental disability due to employment stress becomes more widely recognized in New Jersey, the number of claims filed will probably follow the trend which was established in California during the 1980's.