You Be the Judge

Did Mental Trauma Arise Out of Employment?

After an employee experienced the onset of PTSD at a seminar, a court is asked to examine whether his mental injuries were indeed work-related.
By: | March 7, 2016

A program director/community education manager for Horizon Mental Health Management was also a registered nurse. His typical day included meeting with the psychiatric treatment team to discuss patients, administrative meetings, and attending to marketing needs.


The director attended an annual conference held by Horizon in Texas. During a trauma-sensitivity care training seminar, the speaker, who also worked for Horizon, stated that she wanted attendees to put themselves in their patients’ shoes and imagine how it would feel when asked if they have been physically, emotionally, or sexually abused.

The director stated that the speaker’s statement was not something he had been taught to do as a psychiatric nurse and that he had only taken patient histories on rare occasions. The director said he had been instructed to distance himself from patients.

The director claimed that immediately upon hearing the statement made at the seminar, emotion overcame him, he became overwhelmed, he had a flood of emotions and memories, and he had flashbacks of when he had been sexually abused as a child. He said he ran to his hotel room and took some nitroglycerine because he thought he was having a heart attack. He returned to the seminar, but he still felt sick, nauseous, sweaty, confused, and dazed.

The director stopped working for Horizon soon after the conference. He was diagnosed with psychological injuries, depression, and post-traumatic stress disorder. He had undergone prior treatment for anxiety, depression, panic attacks, crying at work, and suicidal thoughts.

The director sought workers’ compensation benefits. The trial court denied benefits, finding that his conditions did not arise out of his employment. For a purely mental injury to be compensable, the injury must stem from an identifiable stressful, work-related event producing a sudden mental stimulus, and the event must be extraordinary in comparison to the stress ordinarily experienced by a worker in the same type of duty. The trial court concluded that the director’s claimed stress was not unusual. The ruling was appealed.

Was the trial court correct in denying benefits for the director’s mental injuries?

  • A. No. The statement was made by another of Horizon’s employees.
  • B. Yes. The stress to which the director was exposed was not abnormal, extraordinary, or unusual when viewed under an objective standard.
  • C. No. The trial court should have considered the director’s preexisting psychological condition which may have predisposed him to reacting to the particular stress.

How the Court Ruled

A is incorrect. The court pointed out that the speaker’s statement was not directed to the director. Rather it was made to a group of employees in attendance at the conference. Also, the statement was broad and general.


C is incorrect. The court found that an objective standard was applicable in determining whether the event was extraordinary in comparison to the stress ordinarily experienced by a worker in the same type of duty.

B is correct. In Ireton v. Horizon Mental Health Management, LLC, No. E2015-00296-SC-R3-WC (Tenn. 01/19/16, unpublished), the Tennessee Supreme Court held that the director’s mental injuries were not compensable.

The court found that the statement by the speaker was not abnormal, extraordinary, or unusual “in comparison to the stress ordinarily experienced by an employee in the same type of duty” or even in comparison to the stress ordinarily experienced by the director in his capacity as a nurse working in a psychiatric unit.

Editor’s note: This feature is not intended as instructional material or to replace legal advice.

Christina Lumbreras is a Legal Editor for Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

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