Mental Health and Workers’ Comp: What Claims Professionals Need to Know About New York’s Expanded Mental Injury Legislation
In recent years, mental health has taken a more prominent role in workplace injury discussions. With the passage of new legislation in New York, workers’ compensation adjusters and claims professionals must now navigate an evolving landscape where psychological injuries—particularly those not tied to a physical event—are increasingly compensable.
A Shift in the Law: From First Responders to All Workers
On December 6, 2024, Governor Kathy Hochul signed Senate Bill S6635 into law, expanding eligibility for mental injury claims under New York’s Workers’ Compensation Law. Previously, only first responders—like police, firefighters, and EMTs—could file claims for stress-related conditions. Now, any worker in New York State who experiences extraordinary work-related stress may file for benefits related to PTSD, acute stress disorder, or major depressive disorder.
This shift was reinforced by Senate Bill S755, signed on February 14, 2025, which further clarified and codified the provisions related to mental injury claims.
Types of Mental Injury Claims
Claims professionals should now be aware of the three psychological injury claim types:
Physical–Mental: Mental injury resulting from a physical injury (e.g., depression after an amputation).
Mental–Physical: Physical injury resulting from mental stress (e.g., stress-induced heart attack).
Mental–Mental: Psychological injury without accompanying physical harm—the focus of the new legislation.
The most significant change is the broadened eligibility for mental–mental claims, which had previously faced steep legal hurdles.
Key Legal Provisions
Under the revised Workers’ Compensation Law (WCL § 10(3)(c)):
A claim cannot be denied solely because the stress experienced is considered part of the job.
Covered conditions include PTSD, acute stress disorder, and major depressive disorder.
A claim must demonstrate that the condition arose from extraordinary work-related stress, clearly linked to a distinct work-related event or events.
Diagnostic evidence must align with criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), current or immediately preceding version.
Claim Handling Implications for Adjusters
With these changes now in effect, claims professionals should be prepared to:
Be proactive: Watch for mental health claims in all industries, not just emergency response.
Clarify etiology: Review provider documentation carefully for causation details. If unclear, a psychiatric IME may be appropriate.
Expect legal representation: Mental stress claims are complex and are likely to involve legal counsel.
Monitor hearings: Carriers may still contest claims, and litigation is expected to rise as workers and attorneys test the bounds of the new law.
At Viscardi, Inc., we help our clients stay ahead of emerging trends in workers’ compensation. Our Nurse Case Management, Injury Management, and Utilization Review teams support insurance carriers, TPAs, and self-insured employers in managing complex mental health claims—ensuring that care is appropriate, documentation is thorough, and claims are resolved with minimal disruption.