Friday, May 12, 2017

Important Changes Regarding Post-Traumatic Stress Disorder (PTSD) and Law Enforcement: DSM-V vs. DSM-IV-TR PTSD Diagnostic Criteria

This article was originally published in December, 2015 in the Minnesota Police Journal. PTSD was and continues to be an important topic with major implications for Minnesota’s first responders who suffer from PTSD. In October of 2013, the Minnesota workers’ compensation law recognized post-traumatic stress disorder as a covered or compensable injury for purposes of workers’ compensation law. Since then, law makers continue to fight for the rights and benefits of Minnesota’s first responders as well as continue to raise awareness of PTSD, including the re-introduction of a crucial bill in the 2017 legislative session that directly affects first responders who suffer from PTSD.

Written by Dr. Michael Keller, Ph.D and published in the Minnesota Police Journal

Introduction 

There have been some important changes regarding the diagnosis of post-traumatic stress disorder (PTSD), and these changes have a significant effect on those employed as licensed Minnesota Peace Officers relative to such matters as eligibility for disability benefits under the Public Employees Retirement Association (PERA), the Minnesota State Retirement Association (MSRS), and workers’ compensation. Due to changes in Minnesota Law taking place over the past few years, it is now the case that Minnesota Peace Officers must meet the diagnostic standards for PTSD as indicated in the Diagnostic Statistical Manual, Fifth Edition (DSM-5, 2013), whereas previously, the diagnostic criteria for PTSD as indicated in the Diagnostic Statistical Manual, Fourth Edition, Text Revised (DSM-IV-TR, 2000) have been relied upon for the determination of the diagnosis of PTSD.

The official effective date for the transition from DSM-IV-TR diagnoses to DSM-5 diagnoses took place on October 1st, 2015. It was at this time that all medical and psychiatric providers were to cease using diagnostic coding (and relevant diagnostic criteria) relative to ICD-9-CM standards, to diagnostic coding as indicated by ICD-10-CM standards (including any changes relevant to diagnostic criteria of various disorders, conditions or problems). ICD codes (International Classification of Diseases codes), more formally identified as the International Statistical Classification of Diseases and Related Health Problems, is copy written by the World Health Organization (WHO) and owns and publishes the classification. For example, under the DSM-IV-TR, diagnostic coding and ICD-9 coding for PTSD are both identified as 309.81, whereas coding for PTSD under DSM-5 is identified as F43.10 as to ICD-10 and 309.81 diagnostically.

It is important to understand that although the official date for the transition from DSM-IV-TR to DSM-5 took place on October 1st, 2015, changes in Minnesota State Statutes regarding the diagnosis of PTSD requiring DSM-V diagnostic criteria, as in the case of workers’ compensation benefits for Peace Officers, took place prior to October 2015 (see Minnesota Statute §299A.465 and Minnesota Statute §299A.475 for important details regarding PERA, MSRS, and workers’ compensation).

More important than the differences in diagnostic coding between DSM-IV-TR (PTSD, 309.81) and DSM-5 (PTSD, 309.81 F43.10) are the substantive distinctions in the differences between PTSD diagnostic criteria as indicated in the DSM-V as compared to the DSM-IV-TR.

Post-Traumatic Stress Disorder, DSM-V vs. DSM-IV-TR

According to the Diagnostic Statistical Manual, Fifth Edition, (DSM-V), PTSD is described specifically, in part, as follows.

Post-Traumatic Stress Disorder (PTSD) 309.81 (F43.10) – Diagnostic Criteria:
 Note: The following criteria apply to adults, adolescents, and children older than 6 years.

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that a traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse).

Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work-related.

B. Presence of one (or more) of the following intrusive symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic events(s).
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to traumatic the event(s).
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or act as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings).
4. Intense prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
5. Marked psychological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
2. Avoidance of or efforts to avoid external or internal reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and to other factors such as head injury, alcohol or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
2. Reckless or self-destructive behavior.
3. Hyper vigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep Disturbance (e.g., difficulty falling asleep or restless sleep).

F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Specify whether:

With dissociative symptoms: The individual’s symptoms meet the criteria for post-traumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:

1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or time moving slowly).
2. Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).
Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medial condition (e.g., complex partial seizures).

Specify if:

            With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).

American Psychiatric Association (2013). Diagnostic and Statistical Manual, Fifth Edition, Text 
           Washington, DC: American Psychiatric Association (271- 272).

According to the Diagnostic Statistical Manual, Fourth Edition, Text-Revised (DSM-IV-TR), PTSD is described, in summary, as requiring two critical features, as follows: (1) The person has been exposed to a traumatic event whereby they have experienced, witnessed, or were confronted by an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others and, (2) the person’s response involved intense fear, helplessness, or horror. Research informs us that the traumatic event alone does not cause PTSD but that it is the individual perception of the event by the involved person and the thoughts generated about the traumatic event that results in the traumatic emotional and memory response that characterizes PTSD. In other words, the way we think about things shapes how we emotionally respond to things, thus we suggest that individual differences in perception, cognitive appraisal of the event, emotions generated, and memories produced regarding the traumatic event or events are important contributory variables in terms of the development of PTSD in terms of intensity of response. Overall, it is the emotional memory of the traumatic event that seems to be a significant source of PTSD symptoms and complaints as opposed to the material facts of the traumatic event itself.

Among the most significant changes in the DSM-5, which, as indicated above, was released in May of 2013, are both the classification and conceptualization of PTSD. The condition is no longer indicated as being an anxiety disorder, but rather a “Trauma-and-Stressor-Related Disorder.”  Also, the DSM-5 reflects a number of changes relative to PTSD criteria whereas a traumatic event is more clearly defined than it was previously in the DSM-IV-TR. The DSM-5 specifies examples of experiencing or witnessing a traumatic event, such as sexual assault or the repeated indirect exposure to adverse events, such as in the case for public safety professionals, and requires the necessity of being explicit as to how the event was experienced (i.e., directly or indirectly).

Determination of a PTSD Diagnosis

As was the case previously under DSM-IV-TR, and is the case now regarding the DSM-V, the recommended best practices regarding the process to be used in determination of a diagnosis of PTSD includes the completion of a structured interview of the individual wherein some sort of specific instrument or protocol is used so as to identify the triggering traumatic exposure or exposures (e.g., the story of traumatic exposure), the reported and observed associated symptoms and complaints including onset, intensity, frequency and duration and frequency (e.g., individual self-report and the use of some type of PTSD symptom check-list), the completion of psychometric evaluation (e.g., MMPI-2/MMPI-RF testing), and the review of relevant current and past treatment records, if available, depending on the date of injury and onset of problems.

Conclusion

PTSD, whether understood and diagnosed in the context of DSM-IV-TR or DSM-V diagnostic criteria, remains a very serious condition and needs to be taken seriously. It is important to seek and obtain professional help if you think you might be experiencing PTSD.

It is also important to understand that from a clinical diagnostic perspective, if an individual meets DSM-IV-TR diagnostic criteria for PTSD secondary to their work-related traumatic exposure or exposures while working as a licensed Minnesota Peace Officer, they will continue to meet DSM-V PTSD diagnostic criteria going forward. The change from DSM-IV-TR to DSM-5 did not have a more limiting and/or restrictive affect as to an individual potentially meeting diagnostic qualification for a formal diagnosis of PTSD; rather it clarified and more so expanded potential qualification as a result of clarification of what is understood to be a traumatic event and what is meant by exposure or repeated exposures to said traumatic events as compared to the previous criteria of witnessing and/or participating in a traumatic event or events.

Sources:

 American Psychiatric Association (2000). Diagnostic and Statistical Manual, Fourth Edition, Text 
             Revision, Washington, DC: American Psychiatric Association.

American Psychiatric Association (2013). Diagnostic and Statistical Manual, Fifth Edition,
           Washington, DC: American Psychiatric Association (271- 272).

Centers for Disease Control and Prevention (2015). Clarification of Diseases, Functioning, and 
             Disability, Washington DC: U.S. Department of Health and Human Services

Houston, A.A., Webb-Murphy, J., & Delaney, E. (2013). From DSM-IV-TR to DSM-5: Changes in 
            Posttraumatic Stress Disorder, Naval Center for Combat & Operational Stress Control, Boston, MA.

Weathers, F.W., Litz, B.T., Keane, T.M., Palmieri, P.A., Marx, B.P., & Schnur, P.P. (2013), The PTSD 
            Checklist for DSM-5 (PCL-5). National Center for PTSD.


Dr. Michael Keller is a licensed clinical and forensic psychologist who serves a variety of Minnesota and Wisconsin law enforcement agencies as well individual members of the law enforcement community and their families. He is a retired law enforcement officer and a member of the American Psychological Association (Clinical Psychology and Police & Public Safety Psychology Sections) and is a member the Police Psychological Services Section of the International Association of Chiefs of Police.

Dr. Michael Keller, Ph.D., LP
121 Adams Street
Cambridge, MN 55008
763-442-4111
www.psychologicalserviceassociates.com

Ron Meuserby Ron Meuser
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Wednesday, May 3, 2017

Can I Move to Another State While Collecting Minnesota Workers’ Compensation Benefits?

I have been asked many times by injured employees, “Can I move out of state? Will this affect my Minnesota workers’ compensation benefits?” The answer I always give my clients is it depends. And, it truly does depend on a number of factors, including the location of the move and the type of benefits involved. But, we can typically find a way to make the out-of-state move work while still protecting all of the injured workers’ benefits.

Factor 1: Can you perform a diligent job search in your new location?

If an injured employee is completely off of work and collecting temporary total disability (TTD) benefits, he or she is required to conduct a diligent job search. There is no case law or statute that specifically defines “diligent job search” or specifies the number of job contacts that must be made or the geographic area within which jobs must be sought. Rather, whether a diligent job search has been conducted is a fact question for the judge.

The central question I ask my clients when assessing this factor is what is the new area like? Is it a city or a small town? Are there going to be job opportunities there? Will those job opportunities be similar to those that are available in the city they are currently living in? If my client is looking to move to a city that is similarly situated in terms of size and job opportunity then I’m typically confident that he or she will be able to perform a diligent job search in the new location. Of course, if you move to the new location for a job offer, this factor is largely moot unless the job does not come close to replacing your date of injury wages.

Factor 2: Would you be deemed to have withdrawn from the labor market in your new location?

Under Minnesota Statutes section 176.101, subd. 1(f), an employee’s temporary partial disability benefits shall cease if the employee withdraws from the labor market; however, moving to a new community does not preclude an employee from receiving wage loss benefits if there is a reasonable expectation of earning a reasonable livelihood in the town of destination. This is the proper test for determining whether your wage loss benefits will cease after moving to a new community.

If the injured worker moves to a new community where the employment prospects are substantially worse, or virtually non-existent, his or her wage loss benefits will be in jeopardy. The insurer will argue that the move is the reason why the employee cannot find work, not the work injury. An example I often use with clients is a move from the Twin Cities to a small town in Montana. It is fairly clear in this circumstance that the Twin Cities offers greater employment opportunities and the insurer may be able to make a colorable argument that the employee is effectively withdrawing from the labor market. It is a fine line though. The Workers’ Compensation Court of Appeals in Giles v. Minnesota Department of Transportation determined that a move from the Twin Cities to Albert Lea was not sufficient to cut off wage benefits under this theory. The court ruled that Albert Lea was not so sparsely populated to the point where job opportunities were virtually non-existent.

If an insurer does cut off your wage benefits because of a move, benefits can be restarted if you reenter the labor market prior to 90 days after reaching maximum medical improvement (MMI) and before receiving 130 weeks of TTD.

Factor 3: What impact does an out-of-state move have on my rehabilitation benefits?

If an employee voluntarily relocates to another city or town, the same analysis is used for rehabilitation benefits. You will still be able to seek rehabilitation services, including vocational rehabilitation services from your qualified rehabilitation consultant (QRC) as long as there is a reasonable expectation of earning a reasonable livelihood in the town of destination.

Don’t wait to get an attorney involved if you have a Minnesota workers’ compensation claim. The process can be complex and you want to be sure you receive the full benefits you are entitled. Contact Meuser Law Office, P.A. for a free no-obligation consultation and claim evaluation. At Meuser Law Office, P.A. we keep our clients informed of the process as well as what to expect each step of the way. Call us today at 1-877-746-5680.

Ashley Biermannby Ashley Biermann
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Friday, April 28, 2017

In the Line of Duty Injuries: Minnesota State Troopers

Workers’ Compensation Benefits

Minnesota State Troopers are entitled to a variety of benefits to cover medical expenses and wage loss if they are injured in the line of duty. Whether the injuries are due to a car accident, a lifting incident, a slip and fall while chasing a suspect, or wear-and-tear over time, if the State Trooper’s work activities are a substantial contributing factor to the injuries, the Trooper is eligible for Minnesota workers’ compensation benefits.

Minnesota workers’ compensation covers all injuries arising out of and in the course and scope of employment. This includes physical injuries incurred as the result of a specific incident, physical injuries that occur over time due to repetitive use or wear-and-tear, injuries that aggravate or accelerate a pre-existing condition, or post-traumatic stress disorder (PTSD) that is the result of work-related traumatic exposures. Minnesota workers’ compensation benefits include medical expense benefits for reasonable and necessary medical care, including hospital charges, imaging like MRI’s or CT scans, diagnostic tests, surgery, prescriptions, physical therapy, mental health care, chiropractic care, and mileage expenses. If a Minnesota StateTrooper misses time off work or experiences reduced pay as the result of a work-related injury, workers’ compensation pays wage loss benefits including temporary total disability (TTD) benefits, temporary partial disability (TPD) benefits, and/or permanent total disability (PTD) benefits. A State Trooper may also be eligible for rehabilitation services, including retraining benefits, if that Trooper cannot return to his or her former position as a Minnesota State Trooper as the result of a work-related injury.

MSRS State Patrol Plan Duty Disability Benefits

Minnesota State Troopers who suffer in the line of duty injuries may also be eligible for Duty Disability benefits under the MinnesotaState Retirement System (MSRS) State Patrol Plan. A Trooper who suffers an injury or illness that 1) prevents the Trooper from performing his or her normal duties for a period of at least a year, 2) that injury or illness occurred during the performance of inherently dangerous duties that are specific to Troopers, and 3) the duties that the Trooper was performing at the time of the injury or illness were specific to protecting safety and property. In short, if a Trooper suffers an in the line of duty injury while performing “inherently dangerous duties,” and that Trooper cannot return to full duty as a result of the injury, he or she is eligible for Duty Disability benefits. Duty Disability benefits are payable at a base rate of 60% of the Trooper’s high-five salary. Unlike State Patrol Plan retirement benefits, Duty Disability benefits are non-taxable through age 55 or 5 years, whichever is longer. There are extremely complex rules regarding the coordination of Minnesota workers’ compensation benefits and Duty Disability benefits for State Troopers. Discuss these coordination issues with an attorney experienced in handling both workers’ compensation and MSRS pension benefits.

Health Insurance Continuation Benefits Under Minn. Stat. § 299A.465

Minnesota State Troopers who qualify for MSRS State PatrolPlan Duty Disability benefits are also eligible for continued health insurancebenefits under Minn. Stat. § 299A.465. This statute requires the Department of Public Safety to continue to provide health insurance coverage to the disabled Trooper and his or her family, if applicable, as though the Trooper remained on the payroll. This means that the state continues to pay its share of the Trooper’s health insurance premiums. This benefit continues through age 65.

Civil Liability Claims – Auto Accidents

Given the sheer amount of time Minnesota State Troopers spend on the state’s roadways, unfortunately injuries as the result of crashes are quite common. If a Minnesota State Trooper suffers injuries as the result of an auto crash that is the fault of a third party, that Trooper may be able to pursue a civil liability claim against the at-fault driver, in addition to workers’ compensation and MSRS Duty Disability benefits. A civil auto liability claim allows a Trooper to assert claims for losses that are not covered by workers’ compensation, including:
  • future wage loss beyond the time limits available under workers’ compensation
  • future loss of earning capacity
  • pain and suffering
  • loss of enjoyment of life
  • loss of consortium
Coordination of benefits for disabled Minnesota State Troopers is complex. This is a very specialized area of law, and it’s easy to overlook claims or to make mistakes that can cost the Trooper hundreds of thousands of dollars in benefits. For Minnesota State Troopers, to ensure you are maximizing all potential sources of benefits, contact Meuser Law Office,P.A.

Meuser Law Office, P.A. is one of the few workers' compensation law firms in the state of Minnesota that also handles PERA and MSRS disability claims. We've successfully represented hundreds of State Patrol, police officers and firefighters throughout the state for both workers' compensation and PERA/MSRS disability claims. The knowledgeable attorneys at Meuser Law Office, P.A. can help make the process easier to navigate. Contact us today for a free no-obligation consultation by calling 1-877-746-5680

Jennifer Yackleyby Jen Yackley
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Thursday, April 20, 2017

Narrative Request vs Narrative Report

A narrative request is a formal letter sent by your Minnesota workers’ compensation attorney to your treating physician requesting that he or she issue a “causation report” on your work-related condition. A causation report is issued by your attorney, asking your doctor to explain why in his or her medical opinion that he or she believe this condition arises out of the course and scope of your employment.

A narrative request will also ask the doctor to opine to any permanent partial disability (PPD) to which you are entitled. Your doctor will assign you a permanency rating under the Minnesota workers’ compensation PPD schedules based on lack of use or function due to your work-related condition. In his or her narrative report the doctor will also determine if you have reached maximum medical improvement (MMI). MMI signifies that you have reached a plateau in your treatment. You are not necessarily healed or restored to your pre-injury condition but you are not expected to decline or make a substantial improvement in your condition. A permanent partial disability rating cannot be assigned until you reach MMI since the PPD rating reflects a permanent loss of use or function. Once you have reached MMI as determined by the physician, you must be served with the report under Minnesota Statute §176.101, subdivision 3e.

A narrative request differs from a Healthcare Provider Report. A Healthcare Provider Report (HCPR) simply asks the doctor to assign a PPD rating and opine as to whether you have reached MMI. An insurance adjuster may also send your doctor a HCPR. The provider is also not allowed to charge for report pursuant to statute. While a provider will charge for the time associated with reviewing your case and writing a causation narrative report. This report may cost $500 to upwards of $3,000 depending on the complexity of the case. This cost will be paid up-front by your work comp attorney, who will then be reimbursed by the employer and insurer upon a successful resolution of the case.

The narrative request will include a summary of your pertinent medical history collected from your medical records. This summary will set forth the foundation or basis for which your physician had the evidence and information upon which to make a medical opinion. You should disclose to your workers’ compensation attorney every provider from which you have sought treatment for your condition, even pre-existing conditions. If this information is not included, the employer and insurer will have a basis on which to discredit your doctor’s medical opinion. The narrative request will further describe the mechanism of your injury and if necessary for a Gillette, or repetitive motion type injury, a detailed description of your job duties.

The narrative request will also include a set of questions for your doctor to answer, including PPD ratings and MMI determinations as discussed above. The doctor will also be asked to issue restrictions if appropriate, describe surgeries or recommended treatment and the basis for the recommendations, and if the past treatment was reasonable and necessary to cure or relieve the effects of the work-related injury.

Frequently, employees become frustrated at the length of time a workers’ compensation claim takes in the State of Minnesota. Unfortunately, providers take time to respond to requests for medical records, which need to be summarized before a narrative request is sent to the treating physicians. Additionally, it can take months for the doctors to respond to the narrative request due to the time involved in writing a report.

At Meuser Law Office, P.A. we’ve successfully represented hundreds of police officers, firefighters, deputy sheriffs, corrections officers, and State Patrol officers throughout the State of Minnesota for workers’ compensation, PERA/MSRS disability, healthcare continuation, and personal injury claims. We can explain what rights you have and make recommendations to you in terms of how to best protect your rights to those benefits. The knowledgeable attorneys at Meuser Law Office, P.A. will help make the process easier to navigate. Contact us today at 877-746-5680 for a free, no-obligation consultation.

Mary Beth Boyceby Mary Beth
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Wednesday, April 12, 2017

Cumulative Post-Traumatic Stress Disorder and Police Officers

Ten years ago, many people had never heard of post-traumatic stress disorder (PTSD). Today most people associate PTSD with soldiers, who often suffer from the effects of PTSD from a single traumatic incident or exposure in the line of duty. What this means is when you ask a soldier the cause of his or her PTSD, they can usually point to a single incident or set of incidents that sparked the onset of their PTSD symptoms. This is not the case for Minnesota police officers. Many times, PTSD symptoms manifest over the course of time as a result of multiple traumatic experiences, and it is difficult to point to just one incident as the inciting event.

What Causes PTSD?

Many events can cause PTSD in police officers, such as shootings or “shots fired” calls, motor vehicle collisions involving fatalities or severe injuries, hostage situations, dangerous drug busts, domestic dispute calls, child abuse investigations, or any other situation that involves exposure to serious injury or death. There is no rhyme or reason for why one person develops PTSD and another does not. There is also no reason why one particular event “causes” PTSD while another, perhaps more traumatic event, does not. With police officers, PTSD many times occurs as a result of a build-up of events that arise throughout an officer’s career.

The Workers Compensation Act recognizes post-traumatic stress disorder as a compensable injury as of October 1, 2013 and defines PTSD by the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V). The DSM-V specifically describes the types of incidents that are required for a PTSD diagnosis. These incidents include exposure to actual or threatened death, serious injury, or sexual violence in on or more of the following ways:

1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family members or close friend.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s).

The DSM-V provides an example for #4 above, citing to first responders who collect human remains or police officers exposed to details of child abuse.

Other stressful situations may also contribute to an officer’s overall deterioration in mental health, including long hours, politics within the police department, not knowing what the next call will be or when it will come in, and handling the attitudes of others. In addition, officers are often times criticized and investigated for the decisions they have to make within a split second. While this likely contributes to an officer’s mental condition, factors such as these “work stress factors” are not events that lead to PTSD.

Signs and Symptoms of PTSD

There are many symptoms of PTSD. A common symptom witnessed in most of our Meuser Law Office, P.A. clients is their report of having irritable behavior or angry outbursts with little to no provocation. This makes sense since PTSD inhibits one’s ability to appropriately handle stress. On a scale of one to ten, with ten being the most stress you’ve ever had in your life and zero being no stress, a person with PTSD may rate going to the mall or grocery store at a 7 when a person without PTSD may rate it as a 1 or a 2.

Here are other signs and symptoms to watch for:

Irritability or frequent anger
Withdrawal from family and friends
Emotional outbursts
Suspicion or paranoia
Risk taking behaviors such as excessive drinking, drug use or risky sexual behaviors
Insomnia or difficulty falling asleep
Anxiety or panic feelings
Guilt
Nightmares
Panic attacks
Intrusive thoughts
Avoiding people or places
Easily distracted
Lack of concentration
Fatigue
Recurring thoughts
Flashbacks
Judgment errors
Sweating, trembling or shaking
Negative beliefs about yourself
Inability to feel positive emotions
Hypervigilance
Exaggerated startle response

It is important to remember that 10 - 30 percent of first responders will develop PTSD in the course of their career. These injuries can be just as serious and dangerous as physical injuries and should be taken seriously. Early intervention in the form of therapy and/or prescription medication is likely the single best thing you can do for a PTSD diagnosis. There is no one answer for everyone. What may work for one person in terms of treatment may not work for you. However, the faster you seek assistance for your post-traumatic stress disorder symptoms, the greater the chance you have of making a rapid and full recovery.

Under the Workers’ Compensation Act, there are benefits available for Minnesota police officers and first responders who develop PTSD on the job. These benefits include wage loss, rehabilitation, and medical care and treatment. If you or someone you know suffers from PTSD due to a work-related accident or traumatic incident, you should consult with an attorney experienced in this area of the law. At Meuser Law Office, P.A., we have represented many clients with PTSD, including police officers, firefighters, first responders and correctional officers. We understand this nuanced area of the law and work with our client to ensure you receive the full benefits you are entitled. Contact Meuser Law Office, P.A. for a no-obligation consultation today. Don’t let the insurance company unfairly deny you benefits as a result of their misinterpretation of the law surrounding PTSD in Minnesota. Call us today at 1-877-746-5680.

Ashley Biermannby Ashley Biermann
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Friday, April 7, 2017

Minnesota Workers’ Compensation Benefits are Not Taxable

It’s that time of year again! Tax time! This year’s tax filing deadline is April 18, 2017. If you’ve procrastinated, or you’re doing your own taxes, you may be wondering if you need to report your Minnesota workers’ compensation benefits. In other words, are your Minnesota work comp wage loss benefits taxable? The answer is NO!

You are not required to pay income taxes on your work comp benefits, regardless of whether you received them on a weekly basis or as a lump sum settlement. Minnesota workers’ compensation benefits are considered to be compensation for a personal injury under the Federal Tax Code, and therefore are non-taxable.

Other types of benefits that are payable as a result of a work-related injury may also be non-taxable, including PERA Police and Fire Plan or Corrections Plan Duty Disability Benefits, and MSRS State Patrol Plan and Corrections Plan Duty Disability Benefits.

To ensure you are maximizing your eligibility for Minnesota workers’ compensation benefits, contact Meuser Law Office, P.A. for a free no-obligation consultation. Call us today at 1-877-746-5680.

Jennifer Yackleyby Jen Yackley
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Tuesday, April 4, 2017

Am I Eligible for Rehabilitation Benefits if I Have Quit My Job?

Frequently, employers and insurers who are involved in Minnesota workers’ compensation cases do not understand that even if an employee separates from his or her date of injury employer, he or she is still entitled to rehabilitation services of a Qualified Rehabilitation Consultant (QRC). These rehabilitation services include job placement services. A QRC will help an injured worker return to work at a different job within his or her restrictions.

If an employer and insurer terminates rehabilitation services through a rehabilitation request and is refusing to provide job placement services, the injured worker should file a rehabilitation request. The issue must be certified as a dispute under Minnesota Statute § 176.081, subdivision 1 (c). After a mediator at the Department of Labor and Industry (DOLI) will determine whether a genuine dispute exists between the parties and the matter will be scheduled for a rehabilitation conference at DOLI.

As long as an employee remains a qualified employee under Minnesota Administrative Rules part 5220.0100 subpart 22, an employee is entitled to rehabilitation services, including job placement services. In order to be a qualified employee, the employee must be:

(a) permanently precluded or likely to be permanently precluded from his or her usual occupation or job he or she held at the time of the injury;
(b) cannot reasonably be expected to return to suitable gainful employment with the date of injury employer; and
(c) can reasonably be expected to return to suitable gainful employment with rehabilitation services.

By definition if PERA has awarded a Minnesota police officer, firefighter, first responder, or deputy sheriff Duty Disability benefits, he or she is a qualified employee. In order to receive PERA Duty Disability benefits, two doctors must opine that the worker’s disability prevents him or her from working as a police officer or firefighter for at least one year.

Once PERA awards an employee Duty Disability benefits he or she must separate from the county or city. If the police officer or firefighter is working light duty, he or she must separate within 45 days. The injured worker may return to work in a different capacity but he or she cannot work in a position covered by the PERA Police and Fire Plan.

Members who qualify for PERA Duty Disability benefits are actually incentivized to find employment in a non-police and fire plan position. If he or she is not working, the injured worker’s wages are capped at 100% of his or her “high five” between PERA benefits and workers’ compensation wage loss benefits. But if he or she is able to work elsewhere, the member’s wages are capped at 125% among PERA, work comp, and the new job. After the member’s wage reaches 125% then the PERA benefits are reduced a dollar for every three dollars.

Accepting PERA Duty Disability benefits do not signify that the employee is withdrawing from the labor market. The injured worker merely cannot work in the same capacity in which he or she worked before the injury and disabling condition. Injured workers should complete and track his or her job search in order to demonstrate a desire to return to work.

In the Minnesota workers’ compensation case, Erickson v. City of St. Paul, the employee resigned from his employer, who was accommodating his restrictions, in order to accept PERA benefits. (slip. op. (W.C.C.A. April 16, 2007)). The employer and insurer argued because he voluntarily resigned he was not qualified for rehabilitation services, specifically retraining benefits. The court noted that the employee qualified for PERA benefits because of his disability, not because he restricted and that whether an employee is “employed, voluntarily terminates his employment, retires, or relocates does not terminate his or her entitlement to rehabilitation services.”

If an employee does not resign from the position covered by the PERA police and fire plan, he or she will lose entitlement to non-taxable income, 60% of his or her “high five,” health insurance benefits, and survivor benefits. Refusing a job offer does not cut off rehabilitation services nor does being fired for misconduct. Hugill v. Benton County, 64 WCD 220 (2004); Conklin v. Becker County Dev. Achievement Ctr., Slip op., No. WC 10-210 (WCCA Apr. 28, 2011). The court noted in Boutto v. U.S. Steel Corp. that an employee’s decision to accept the employer’s retirement incentive package should not place him in a worse position than someone discharged for misconduct. (July 18, 2007 WC06-288.)

Meuser Law Office, P.A. is one of the few workers’ compensation law firms in the state of Minnesota that also handles PERA and MSRS disability claims. We’ve successfully represented hundreds of State Patrol, police officers and firefighters throughout the state for both workers’ compensation and PERA/MSRS disability claims. If your employer or insurer has denied rehabilitation services, contact an attorney at Meuser Law Office, P.A. for a free, no-obligation consultation. Our knowledgeable attorneys handle Minnesota workers’ compensation cases on a daily basis and are very familiar with the most current laws to determine what you are eligible for. We will ensure you receive the full benefits you are entitled. Call us today at 1-877-746-5680.

Mary Beth Boyceby Mary Beth
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