PTSD late effects
Can damage from late psychological consequences (post-traumatic stress disorder) be claimed by the statutory accident insurance?
Basically yes. However, a prerequisite is that a post-traumatic stress disorder (PTSD) is diagnosed as accurately and promptly as possible after the accident according to the internationally recognized systems ICD 10 or DSM IV. The accident must always be suitable to cause the present mental impairment.
Both were denied in a case that the LSG NRW (judgment of 29.08.2019 - L 15 U 511/17) had to decide. In 1997 the professional plaintiff witnessed two robberies as a bank employee. These were recognized as occupational accidents within the meaning of Section 8 (1) SGB VII. The applicant also received a combined psychotrauma-pain therapy from the professional association in 1999, however the diagnosis of PTSD was denied at the end. In 2006 the applicant fell ill with an adjustment disorder with anxiety and a depressive reaction. An application for this service was rejected by the BG.
The applicant was unable to verify a prompt intial response (A criterion according to ICD 10) directly after the 1997 attacks, nor flashbacks or intrusions in the subsequent period (B criterion).
In one case of the LSG Hessen (judgment of 10.10.2019 - L 3 U 145/14), a now-retired street keeper tried to have a mental illness recognized as an occupational disease. During his professional life he had to be present in numerous traffic accidents with fatalities and serious injuries. First of all, the PTSD is not included in the list of recognized occupational diseases. Recognition as a how-to illness was rejected because there was a lack of reliable scientific knowledge that showed a connection between repeated use as a first aid worker and psychiatric illnesses.
Psychologically traumatic events can be classified as occupational accidents. In order to receive benefits from the statutory accident insurance for resulting damage, specialist diagnosis should be carried out as soon as possible.
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