New Iowa Supreme Court Decision Lowers the Causation Standard to Receive Workers’ Compensation for Purely Mental Injuries | Dentons


The Iowa Supreme Court’s recent decision in the case Tripp v. Scott Emergency Commc’n Ctr. lowers the burden required to receive workers’ compensation for many injured workers in Iowa who suffer purely mental injuries while on the job.

Employment-Related Personal Injuries and Workers’ Compensation

Under Iowa law, workers can receive compensation for all “personal injuries” sustained “arising out of and in the course of employment.”

In the Dunlavey case, the Iowa Supreme Court clarified that “personal injuries” include physical injuries as well as mental injuries caused by physical trauma, such as memory issues resulting from a head injury. These are commonly referred to as mental-physical injuries. The Court also held it includes purely mental injuries sustained on the job or mental injuries caused solely by mental trauma (such as depression caused by mental overexertion). These injuries are often referred to as mental-mental injuries.

While the Court has long found mental-mental injuries are compensable, the injuries must still arise out of and in the course of employment. Under Dunlavey, causation is demonstrated by establishing both “medical” and “legal” causation. Medical causation requires a showing that the mental injury was caused by employment activity. Legal causation, on the other hand, is typically more complicated, and the standard for establishing it has changed over time.

The Iowa Supreme Court’s Previous View of Legal Causation of Mental-Mental Injuries

In Dunlavey, an employee developed extreme depression over a period of time following a significant increase in workload and stress on the job. The Iowa Supreme Court determined that to establish legal causation between the increased stress on the job and the development of depression, it needed to be shown that the depression was “caused by workplace stress of greater magnitude than the day-to-day mental stresses experienced by other workers employed in the same or similar jobs.”

In Brown, the Iowa Supreme Court later modified its view of legal causation by carving a different standard for mental-mental injuries based on sudden, identifiable, and traumatic events of an unexpected cause or unusual strain. In this case, a gas station clerk suffered from post-traumatic stress disorder (PTSD) after witnessing a shooting and being threatened at gunpoint on different occasions, all in the same week while on the job. The Court concluded that because these traumatic events were sudden, easily identifiable, and directly preceded the development of PTSD, causation was much more apparent, especially considering the stressful and traumatic events were unexpected for a gas station clerk.

After consolidating Dunlavey and Brown, the Court previously established these approaches to legal causation in mental-mental cases. If the mental-mental injury results from:

  • Aggregated employment stresses over a period of time, then the stresses causing the mental injury must be of a greater magnitude than the day-to-day mental stresses experienced by other workers employed in the same or similar jobs.
  • Specific stressful events, then the stressful events causing the mental injury must be of a sudden and traumatic nature and must be unexpected or unusual. The unexpected or unusual characteristics of the stressful events must be unexpected or unusual for the particular worker at issue in their particular type of job.

The Iowa Supreme Court’s New View of the Legal Causation of Mental-Mental Injuries

Following the Court’s recent decision in Tripp, when a mental-mental injury is the result of a specific stressful event, the unexpected or unusual characteristics of the event are no longer required to be job-specific.

The Tripp case centers around an employee who worked as an emergency dispatcher. While working, the employee received a traumatic call from a mother whose baby was dying. Following this call, the employee suffered from PTSD and was no longer able to work as a dispatcher.

Based on the previous standard established in Brown, this mental-mental injury would likely not be compensable because traumatic phone calls are not unusual nor unexpected for somebody working as an emergency dispatcher. The Court, however, did find the employee’s PTSD to be a compensable mental-mental injury because such a phone call is unusual and unexpected for employees in general, and holding first responders to the previous job-specific standard would make it nearly impossible for them to ever have a compensable mental-mental injury.

The Court rationalized this expansion of the legal causation standard by noting there is no legal basis for the argument that emergency responders have “assumed the risk” by accepting the job. Workers’ compensation in Iowa is a “no fault” statute, so workers should not be denied benefits because they have agreed to perform a job that could be mentally stressful.

This was a narrowly won issue. The Court split with four in the majority and three dissenting. In her concurrence, Chief Justice Christensen pointed out that legislative action on this matter should be considered to address PTSD among first responders specifically. In his dissent, Justice Waterman focused on the principles of stare decisis to argue the Court should adhere to long-standing precedent on legal causation in denying workers’ compensation benefits in this case.

What does this mean for Iowa employers and insurance companies going forward?

This Iowa Supreme Court decision establishes that legal causation of mental-mental injuries resulting from specific traumatic events can be established through non-job-specific means. As long as the event was of a sudden, traumatic, and unexpected nature to the employee, legal causation can be established even if the employee or similar employees have regularly experienced similar trauma before in their line of work.

Employers and insurance companies should be cognizant that the more generalized standard for legal causation may increase uncertainty as to whether a particular workers’ compensation claim is compensable. Their investigation into compensability may have to go outside the “workplace stressors…experienced by other workers employed in the same or similar jobs.”

Arguably this expanded legal causation standard only applies to occupations that commonly experience traumatic, stressful incidents as part of their job (such as first responders). If you have an injured worker in one of those occupations, you may expect to see more claims from those employees for mental-mental injuries.


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