Are Mental Health Conditions Covered Under Workers’ Compensation in North Carolina?

Some days at work can wreck you. A bad meeting, a screaming boss, a project that implodes at the last minute. But what happens when a bad day turns into weeks of anxiety, sleepless nights, and depression you can’t shake? Could your mental health struggles qualify for workers’ compensation in North Carolina?

It’s not a silly question. More people are asking this, especially as mental health has entered the spotlight alongside physical injuries in the workplace. While the law is still lagging in some ways, North Carolina offers a path for workers whose emotional wounds run deeper than everyday stress.

Can you get workers’ comp for mental health in NC?

The short answer is sometimes.

The long answer is that it depends on what happened, what and how you’re feeling, and whether you can prove the connection between degrading mental health and workplace stressors.

North Carolina’s workers’ compensation law is built around the idea of covering injuries or diseases that arise in the course of employment. Traditionally, that meant things like falls, machinery accidents, or exposure to harmful chemicals and toxic substances. Mental health? Not typically, unless caused by something specific and unusual in the workplace.

According to the North Carolina Workers’ Compensation Act, psychological injuries can qualify, but only under strict conditions. Ordinary stress or just feeling overwhelmed doesn’t count. There must be an identifiable workplace event or trauma that triggered mental deterioration.

What mental health conditions may qualify?

Not all emotional distress qualifies because stress is part of life. We’re talking about severe, diagnosable conditions that develop as a direct result of something that happened on the job, which may include:

• PTSD (Post-Traumatic Stress Disorder). This condition is often seen in first responders (EMTs) or employees who witness traumatic events, like workplace accidents, on-site fatalities, or violence.
• Major depressive d This condition is considered a severe mental health issue, especially when it’s linked to traumatic on-the-job incidents.
• Severe anxiety or a panic d This condition is taken more seriously for workers’ compensation claims when caused by exposure to workplace violence, threats, or catastrophic events.
• Adjustment d This condition can occur when a person has a challenging time coping after trauma in the workplace. However, these are more difficult to prove unless tied to specific incidents.

According to the National Institute of Mental Health (NIMH), around 8% of Americans will experience PTSD at some point in their lives, and rates are higher for those in high-risk professions. So, yes, mental health claims can be genuine, and in some cases, legally valid.

But how do you prove it was work-related?

This is where things get tricky.

In North Carolina, your mental health condition must arise from a “specific, identifiable, and traumatic incident” at work. That’s legal-speak for something unusual had to happen, and it had to be serious.

Here are two scenarios to help understand what may be eligible and what may not qualify.

• Possibly eligible: A warehouse worker sees a coworker suffer a gruesome injury that causes the loss of a limb, but the worker later develops PTSD, including nightmares, flashbacks, and fear of workplace equipment.
• Probably not eligible: A sales manager feels anxious every day because of looming deadlines, toxic emails, and the stress of daily tasks.

The second case may be emotionally devastating, eventually morphing into something more serious than stress, but under NC law, it won’t qualify as-is. North Carolina courts consistently maintain that everyday workplace anxiety isn’t enough for workers’ compensation.

You need a direct link between a specific incident and a professional mental health diagnosis.

Why are these cases so hard to win?

Mental health injuries don’t show up on an X-ray. There’s no cast or crutches. Unfortunately, that invisibility often leads to reasonable doubt, especially for insurance companies. Insurers may argue that your condition is exaggerated or unrelated to work. Or, if you’ve struggled with mental illness before, they may claim your job isn’t the issue. Additionally, many people wait to seek help, making it harder to tie a mental health problem directly to workplace incidents.

The National Council on Compensation Insurance reports that “mental-only” workers’ comp claims in NC (without physical injuries) face a higher burden of proof and are less likely to be approved. This means documentation is everything, from therapy notes and medical records to witness statements.

A key ally will be a mental health professional

To stand a chance, you’ll need an evaluation from a licensed mental health provider, ideally experienced in diagnosing workplace trauma. The expert must diagnose your condition based on the DSM-5 criteria, make a diagnosis-to-workplace connection, and recommend a treatment plan with a focus on how the condition affects your ability to work.

Courts and the North Carolina Industrial Commission lean heavily on this kind of professional documentation and evidence. Without it, even the most sincere, genuine claim may be denied.

The process of filing a mental health workers’ compensation claim in NC

If you think your mental health workers’ comp case may qualify, follow this process:

Notify your employer as soon as possible, then file a Form 18 with the North Carolina Industrial Commission. Seek medical evaluation, which may be a provider chosen by your employer’s insurance.

Be prepared for push-back. If your claim is denied, which is common in mental health cases, you can request a formal hearing. You can appeal to higher courts, all the way to the NC Supreme Court, if necessary.

Each step is deadline-sensitive and evidence-heavy, so don’t drag your feet or try to wing it.

Do you need a lawyer for this?

Think of it this way: would you argue a complex medical case alone, without a doctor?

Navigating the legal hoops of a mental health claim is exhausting, especially when you’re dealing with emotional strain. However, a skilled North Carolina workers’ compensation attorney can:

• Ensure paperwork is complete and on time.
• Help gather medical evidence and expert witnesses.
• Fight back against insurance denial and delay tactics.
• Represent you at hearings and through appeals.

With the right legal advocate, your chances of success increase dramatically, and you get peace of mind knowing you’re not fighting alone.

Contact Price Petho & Associates for guidance and a no-obligation case review.