PTSD & Mental
Injury Workers' Comp.

01What changed on January 1, 2025.

For most of New York's workers' compensation history, mental injury claims faced a near-fatal defense: the carrier could argue that the stress was just part of the job — "no greater than that which usually occurs in the normal work environment" — and the Workers' Compensation Board would dismiss the case. That worked. Most stress-only claims died on it.

The defense was narrowed in 2017 to protect first responders (police, firefighters, EMTs) from the "normal work environment" argument for trauma-related mental injuries. But the protection stopped there. A nurse who watched dozens of patients die during the COVID-19 pandemic, a teacher repeatedly assaulted in a classroom, a transit worker who experienced a fatality on the tracks — none of them had the same protection.

Senate Bill S6635, signed by Governor Hochul on December 6, 2024 and effective January 1, 2025, expanded the protection to every New York worker. Senate Bill S755, signed February 14, 2025, codified additional clarifying provisions. Workers' Compensation Law §10(3)(b) now bars the Board from denying a mental injury claim solely on the ground that the stress was no greater than what's normally encountered in the work environment.

02The three types of psychological claims.

NY workers' comp recognizes three categories of mental injury, and the type of claim materially affects how it's analyzed:

• Physical–Mental. A physical injury produces a mental condition. A worker with a serious back injury develops major depression because of chronic pain and inability to work. These have been compensable for decades and remain the most straightforward category.
• Mental–Physical. Mental stress produces a physical injury. Classic example: a stress-induced heart attack. Still compensable, but the medical causation has to be tightly documented.
• Mental–Mental. Work-related stress produces a mental injury without a physical precursor. PTSD from witnessing a workplace fatality. Major depression from sustained workplace harassment. Acute stress disorder from a violent assault. This is the category transformed by the 2025 law.

03What "extraordinary work-related stress" means now.

The 2025 law didn't eliminate the requirement that the stress be "extraordinary" — it changed how the Board can evaluate whether it was. The Board can no longer dismiss a claim because the stress was typical for the worker's job. Instead, the analysis now considers:

• The diagnosed condition itself — PTSD, acute stress disorder, and major depressive disorder are explicitly named in the statute as covered conditions, with diagnosis evaluated under the current or immediately preceding edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders).
• The triggering event or events — the stress must arise from a "distinct work-related event" or pattern of events. A specific incident is the easiest case; cumulative trauma is harder but not impossible.
• The job duties and the industry — what was the worker exposed to, how often, in what context.
• The impact on the worker — how the condition manifests in their life and ability to work.

Under this framework, a hospital nurse who witnessed extraordinary mortality during COVID, a school employee assaulted by a student, a transit worker exposed to a fatality, a corporate employee subjected to extreme harassment — all have potentially viable claims that would have been barred before 2025.

04What the medical record needs to look like.

The single most-important thing in a mental injury case is the contemporaneous medical record. Three pieces are critical:

• Treatment from a Board-authorized mental health provider — psychiatrist, psychologist, or licensed clinical social worker authorized by the New York State Workers' Compensation Board. Treatment from non-authorized providers can support the case but doesn't drive Board decisions the same way.
• DSM-criteria diagnosis — the diagnosis has to track the actual diagnostic criteria for PTSD, ASD, or MDD as set out in the DSM. "Stressed out" or "burnt out" doesn't establish a Board-recognized condition.
• Causation narrative — the medical record needs to specifically tie the diagnosis to the workplace event(s). Vague references to "stress" don't satisfy the causation element. The provider needs to identify what happened, when, how it produced the condition, and why the condition is workplace-related rather than from another cause.

05What carriers are still doing to defend these cases.

Even after the 2025 expansion, carriers have several remaining defenses they're using aggressively:

• The "lawful personnel action" exclusion. Mental injury claims caused by routine personnel decisions — discipline, performance reviews, transfers, demotions, terminations — are still excluded if the employer's action was lawful and made in good faith. This excludes a lot of "stressed by my boss" cases. It does not exclude harassment, abuse, or bad-faith employer conduct.
• Pre-existing condition arguments. If the worker had a prior mental health history, the carrier will argue the new condition is just a continuation of the old one, not a new work-related injury. Aggravation of pre-existing conditions is compensable in NY, but the carrier will fight this hard.
• Causation challenges. Carriers commission psychiatric independent medical examinations (IMEs) that frequently conclude the condition is unrelated to work, related only partially, or reflects pre-existing pathology. Counter-evidence from treating providers is necessary.
• The "extraordinary" threshold itself. Even though the Board can no longer dismiss a claim as "no greater than normal," the carrier can still argue the stress wasn't "extraordinary" enough to qualify. The statute hasn't been heavily litigated yet, so the contours of "extraordinary" in 2025-onwards practice are still developing.

06Common questions about mental injury cases.