Posts Tagged ‘suicide’

Workplace suicides are climbing; Highest in law enforcement, farming, auto repair

Wednesday, April 22nd, 2015

“Between 2003 and 2010, a total of 1,719 people died by suicide in the workplace. Workplace suicide rates generally decreased until 2007 and then sharply increased. This is in contrast with non-workplace suicides, which increased over the study period. Workplace suicide rates were highest for men (2.7 per 1,000,000); workers aged 65-74 years (2.4 per 1,000,000); those in protective service occupations (5.3 per 1,000,000); and those in farming, fishing, and forestry (5.1 per 1,000,000).”

From the recent study of workplace suicides between 2003 and 2010, published in the American Journal of Preventive Medicine, Suicide in U.S Workplaces, 2003-2010:

Aimee Swartz looks at the study data and the issue of suicide in Workplace Suicides Are on the Rise in a recent issue of The Atlantic, noting that In 2013, the last year for which data are available, 270 people in the U.S. committed suicide at work – a 12 percent increase over the prior year.

There are many factors that contribute to the rise. Mental health experts caution that potential causal factors can’t be generalized based on occupation, but that job factors may present additional stressors that tip the balance. Individual factors such as depression, financial losses, mental and physical health issues play a role.

Swartz looks at potential contributing job factors in each of the highest professions. In law enforcement, trauma is high and a “macho” culture means that people often are reluctant to share or deal with feelings of stress that may be perceived as weakness, Plus, ease of access to a methodology may come into play: 84% of law enforcement suicides involved a firearm. In farming, isolation and financial losses are contributing factors. In the auto repair industry, many think that long-term exposure to chemical solvents may be linked to depressive symptoms.

Mental Health Daily looks at 15 common causes of suicide, as well as the Top 11 Professions with Highest Suicide Rates

  • Medical Doctors 1:87
  • Dentists 1:67
  • Police Officers 1:54
  • Veterinarians 1:54
  • Financial Services 1:51
  • Real estate 1:38
  • Electricians 1:36
  • Lawyers 1:33
  • Farmers 1:32
  • Pharmacists 1:29
  • Chemists 1:28

Farmer suicides on the rise
Madeleine Thomas of Grist takes a deeper look at farmer suicides in her excellent article How can we stop farmer suicides? Thomas says that “farmer suicides tend to increase when farm economics falter.” Rates were high during the farm crisis of the 1980s, when more than 900 farmers took their own lives. Many mental health experts fear that current hardships may lead to an increase in farmer suicides. Calls to hotlines are spiking, with droughts, cold, heavy snow and other climactic woes taking a deep financial toll.

Other factors include the isolated, insular nature of rural farming and easy access to weapons. When the business of farming falters for family farms, it can be ruinous for families, and farmers are often unprepared for other professions.

Experts say that behavioral health in farming populations is an underfunded and often ignored public health issue, particularly in an era when funds for the CDC and the National Institute of Occupational Safety and Health are scarce and funding priorities compete.

“Behavioral health is the area of healthcare that agricultural people understand the least well,” says Michael Rosmann, a licensed clinical psychologist specializing in agricultural behavioral health and one of the field’s leading researchers. “It is the area that probably is in most need of research and clarification so that we improve the understanding and treatment of behavioral health issues.” Rosmann and other experts believe the country’s rural agricultural population should be classified as a health disparity group, which according to the CDC, would mean that farmers consistently face greater barriers to proper healthcare due to the unique environmental, cultural, and economic factors. If farmers and rural America were more widely recognized as a health disparity, more government funding could be directed toward addressing the issue.”

National Suicide Prevention Lifeline (U.S.) 1-800-273-8255

Officer Down: Police, PTSD and Suicide

Monday, August 13th, 2012

Last month, there was a story about a South Carolina sheriff who was denied workers comp benefits for mental distress that he suffered after fatally shooting a suspect. In Brandon Bentley v. Spartanburg County, and S.C. Association of Counties SIF, the South Carolina Supreme Court upheld a lower court denial saying that “…the use of deadly force is an expected and standard part of being a sheriff and is “not an unusual or extraordinary employment condition” that might qualify for workers’ compensation under the state’s restricted coverage for purely mental injuries. In citing statistics, the Sheriff had unsuccessfully tried to demonstrate that such a shooting was indeed an extraordinary event in Spartanburg County. “
The Court noted that it made its decision according to the law as it is written but “… the court did say the state law related to mental injuries should be updated. If South Carolina lawmakers revised state law, it would join a handful of others, wrote the court. Hawaii, Michigan, New Jersey, New York and Oregon already do not require that the conditions of employment be unusual and extraordinary in order for someone to collect compensation.” (Source: Court brings new focus on mental health of law enforcement.)
Hopefully, his community or his police force sees the wisdom of extending some counseling to this officer, despite the denial of full benefits. Re-examining this issue makes good sense. While risks may well be part of the job, people are not automatons that can shut out the emotional residue of terrible events, regardless of training. PTSD is very real, and we must get better at dealing with it. This story was brought to mind again after watching the hard-working police Chief of Aurora Colorado reporting on the gruesome task that his staff faced in responding to the tragedy. In one of his daily updates, his voice broke when he spoke of the stress and toll this took on first responders.
Left untreated, the effects of PTSD on law enforcement can be terrible. In 2012 so far, more police have died by their own hand than by gunfire. According to Badge of Life, a police suicide prevention program, there have been 73 police suicides this year vs. 19 officers killed by gunfire. Badge of Life is conducting A Study of Police Suicides. The first full study of police suicides in all 50 states was published in 2009 in the International Journal of Emergency Mental Health. At that time, the suicide rate for police officers was 17/100,000, compared to the rate for the general public of 11/100,000 and 20/100,000 for the Army.
Badge of Life points us to a documentary that is in progress on the topic, Code 9 Officer Needs Assistance. It’s being co-produced by the wife of a retired state trooper suffering with PTSD, exploring the darker side of law enforcement as it tells the stories of police officers and their families who are now suffering the mental anguish of the careers they chose, which has led some to suicide. Click the above link or the image below to see a powerful excerpt from the documentary. You can get more information on the Code 9 Facebook page.
officer-down
Related Resources
Law Enforcement Use of Deadly Force Incidents: Helping Reduce the “Second Injury”
Remember to save yourself: The importance of managing critical incident stress (PDF)
Law Enforcement Traumatic Stress: Clinical Syndromes and Intervention Strategies
Suicide Prevention Resource Center

Pennsylvania Death: Work Related, Not Compensable

Monday, August 1st, 2011

David Little worked for B & L Ford in Ashland, Pennsylvania. He suffered a shoulder injury in October 2005. He worked light duty up until January 19, 2006, when the employer received a letter from his attorney stating he was unable to perform any manual labor. The employer advised Little to secure a note from his doctor regarding his ability – or inability – to work. His doctor gave Little a letter stating he was unable to work, but before Little had the opportunity to present the letter to B & L Ford, they sent Little a letter of their own, terminating him.
Little spent a weekend brooding over the termination. He called his wife home from her job on Monday. She found Little at the kitchen table, holding the termination letter. He stood up and then collapsed from a heart attack. Emergency workers had to pry the letter from his hand. Little died later that day at a hospital.
Was this a work-related fatality? Little’s widow filed two workers comp claims, one for Temporary total benefits up until the death, and one for death/survivor benefits.
Small Victory, Big Loss
A workers comp judge awarded temporary total disability benefits up to the date of Little’s death; once Little became “unavailable” for work (i.e., dead), the benefits ceased. On the issue of a work-related fatality, the judge found – and the Commonwealth Court of PA upheld – that the death was not work related, as it neither occurred “in the course and scope of employment” nor did Little’s activities on that fatal day “further the interests” of the employer.
There is no question that the loss of his job was a significant, perhaps predominant, factor in Little’s death. However, personnel actions (discipline, demotions and terminations) are generally excluded from workers comp coverage. The sequence of events that began with his attorney’s letter culminated first in the loss of the job and then in a fatal heart attack.
Given that Little had filed a workers comp claim and the employer apparently fired him because of his injury, the widow might be able to sue for wrongful termination. But the courts have made it clear that aside from a modest indemnity payment for lost time, workers comp will provide the widow no solace and no support for the work-related loss of her husband.

New York: What Is Compensable May Not Be Just

Monday, July 18th, 2011

Gary Veeder had the kind of job TV viewers love: for 31 years he was a scientist in the New York State Police Forensic Investigation Center. He specialized in trace evidence, examining fibers, arson residue, footwear impressions, glass, hair and other evidence gathered in criminal investigations. His findings carried significant weight in criminal trials. People went to jail based upon his evidence. Alas, a state investigation found significant problems in 29 percent of Veeder’s 322 cases. That’s a lot of problems – and a lot of jail time – for people who may or may not have committed crimes.
As the investigation into his work unfolded, Veeder first retired and then committed suicide by hanging himself in his garage. Given that the stress leading to the suicide was predominantly caused by work, his widow filed for workers comp benefits. The claim was denied, on the basis that the stress was the result of personnel actions, which are excluded from comp eligibility.
The case wended its way to the Appelate Division of the NY Supreme Court, where the decision to deny benefits was reversed and the case sent back to the workers comp board for reconsideration.
Nothing Personnel
The reversal was based upon a simple, rather stark conclusion: at the time of Veeder’s suicide, no personnel actions had been implemented. The state was investigating the situation; they had uncovered problems in Veeder’s work, but they were on a narrowly defined “fact finding” mission. No action had been taken against Veeder: he was not suspended or demoted or disciplined in any manner. Thus the stress was purely the result of the investigation, not of any personnel action.
In other words, had the employer simply announced to Veeder that the investigation was the initial phase of a disciplinary process, he would probably not have been eligible for workers comp. The only facts that count: he was under enormous work-related stress (of his own making) and he killed himself as a direct result of the work-related situation. And because comp is no fault, it appears that Veeder’s widow will be eligible for burial and indemnity benefits.
Is this fair? Is this just? Maybe yes, maybe no, but these questions themselves are not relevant in the determination of compensability. The claim may still be denied, but some other basis of denial must be found.
Hard Time
Veeder did his job poorly, but he was never held accountable by his superiors. A case can be made that Veeder’s widow is an innocent party, that she is entitled to benefits for her husband’s “work-related” death – despite the fact that virtually all of the stress was of Veeder’s own doing. Meanwhile, quite a few people convicted on corrupted evidence are serving hard time. Some were probably guilty, others completely innocent. But in cases where the lynchpin of conviction was Veeder’s incompetent work, all deserve to go free. This is unlikely to happen. Is this fair? Is this just? Nothing “maybe” about it. Justice – to this point, at least – has certainly not been served.

NFL and Dementia: A Changing of the Guard

Wednesday, May 4th, 2011

Last month we blogged the suicide of Dave Duerson, a former NFL star who killed himself at the age of 50. In order to preserve his brain for study, he took the unusual step of shooting himself in the chest. He suspected – and the subsequent autopsy confirmed – that he suffered from chronic traumatic encephalopathy, a degenerative and incurable disease that is linked to memory loss, depression and dementia. A definitive diagnosis is available only through an autopsy.
Among the many ironies surrounding this sad tale is the fact that Duerson sat on the six person NFL committee that reviewed claims for medical benefits submitted by retired players. Duerson was known for his harsh line on these claims, apparently voting to deny benefits in many cases (the votes of individual committee members were not recorded). He even testified before a Senate subcommittee in 2007, supporting the NFL’s position that there was no definitive relationship between repeated concussions and subsequent dementia.
The days of denial appear to be over. Dr. Ira Casson, who represented the “prove it” mentality of the NFL, is no longer actively involved. The medical evidence is accumulating; while some refuse to connect the dots, it’s increasingly clear that repeated brain trauma (concussion) is often directly related to a precipitous decline in brain function in the post-gridiron years.
Old Game, New Order
The NFL is trying to improve the safety of its players. The new rules limiting return to the playing field after a concussion are taking root. Helmet to helmet hits are being penalized with increasing financial severity. But even as the league tries to limit future exposures, the fate of retired players looms large. There will be increasing numbers of claims for disability, including workers comp where applicable, by players who face a substantially diminished burden of proof to connect dementia to playing field (“workplace”) exposures.
It is painful to contemplate the agony of Dave Duerson’s final days. Confronted with the incontrovertible evidence of his own demise, he must have realized how wrong he had been in taking the company line on dementia. He knew what his own autopsy would reveal: a brain damaged by chronic traumatic encephalopathy, caused by repeated trauma. His choosing to shoot himself in the chest was a farewell gesture, not only to his own life, but to the beliefs that had led him to take a hard line with his former colleagues. A loyal member of the “old guard,” he ended his life with the unmistakable and moving embrace of the new order.

A Bullet to the Heart

Tuesday, March 1st, 2011

Dave Duerson was a star safety in the NFL. He used his head in the way that aggressive defensive backs often do – as a battering ram to bring an opponent down, maybe even jar the ball loose. He was articulate, generous and in his post-football life, successful. So it saddened many of his friends and colleagues to learn that he had committed suicide last month. But even in this last, desperate act there was a method to the madness: he shot himself in the chest, so that his brain would be left intact. He was convinced that the downward spiral of his life over the past few years was due to football-related brain damage – chronic traumatic encephalopathy. He texted his ex-wife just before he shot himself, requesting that his brain be given to the NFL brain bank. Just in case she did not get the message, he left a written note with the same instructions.
We have blogged the issue of concussions in the NFL and their potential for long-term brain damage. As this prior blog pointed out, a changing of the NFL’s medical guard indicates that the league finally appears willing to confront the issue head on (so to speak). They no longer systematically deny a connection between concussions on the field and severe cognitive problems after football careers come to an end.
Over the past few years, Duerson was in a downward spiral. He lost his business to bankruptcy. He (uncharacteristically) assaulted his wife, who soon felt compelled to end their marriage. While his friends did not see major changes in his behavior, he talked openly of his fears of dementia. He suffered short-term memory loss, blurred vision and pain on the left side of his brain. He looked into the future and despaired at what he saw coming. At the time of his death, Duerson was only 50.
Suicide as Political Act
Duerson’s last gesture was an explicitly political act. He was convinced that his life problems – and the rapidly diminishing quality of that life – were directly connected to his years as a football player. So he not only decided to end his life, he made sure that suicide would leave his brain intact for research. The NFL has been (belatedly) collecting the brains of deceased players willing to donate them, to try and determine the impact of repeated violent collisions on aging. At this point, there is not much doubt of the causal connection – not in every individual who played the game, but surely in a significant percentage who suffered from multiple concussions.
With this connection medically proven, the burden falls on the NFL to improve player safety. That will not be easy. This past season, a number of players – most notably the Steelers linebacker James Harrison– complained about the newly implemented fines for helmut to helmut hits, defined as:

“using any part of a players helmet (including the top/crown and forehead/hairline parts) or facemask to butt, spear, or ram an opponent violently or unnecessarily; although such violent or unnecessary use of the helmet is impermissible against any opponent, game officials will give special attention in administering this rule to protect those players who are in virtually defenseless postures…”

Duerson the player would have agreed with Harrison about the rule. Duerson the retiree would have supported it. Experience is an exacting and often cruel teacher. As Duerson’s sad demise demonstrates, what we choose to ignore in the prime of life may give birth to demons that haunt us as we age.

Cavalcade of Risk and assorted noteworthy news items from the blogosphere

Wednesday, December 1st, 2010

Check out this week’s Cavalcade of Risk, which is hosted by Nina Kallen, a Massachusetts attorney who runs the blog Insurance Coverage Law in Massachusetts. These carnivals are a good way to discover new blogs and we are happy to discover this one, right in our own backyard.
Flammable Ice Cream – an interesting Loss Prevention case study from Liberty Mutual that addresses the issue of flammable liquid hazards in unexpected place.
America’s Best Hospitals RankedComplex Care Blog offers links to the recent rankings, as well as an interesting video on thinking differently about health care from the Mayo Clinic.
Beneath the Bell Jar: Companies Confront a Rise in Workplace Suicides – Emily Holbrook looks at this tough issue in the November issue of Risk Management.
Employee whistleblower protections in food new safety law – at Today’s Workplace, attorney Jason Zuckerman discusses the robust whistleblower protections included in the FDA Food Safety Modernization Act (FSMA), which are included to ensure that workers can disclose food safety concerns without fear of reprisal. He offers a detailed overview of the provisions.
Update on OSHA’s worker safety in construction efforts – OSHA Deputy Assistant Secretary Jordan Barab’s keynote speech, which was delivered at the Building Trades Employers’ Association of New York 2010 Safety Conference.
TSA Brings Problems on Itself – we discussed TSA employee stress earlier in the week. Workplace human behavior consultant and author Aubrey Daniels suggests that better attention to service and training might go a long way to reducing traveler tension – and would also, no doubt, make things easier for the screeners themselves.
Fatal occupational injuries at road construction sites, 2003-07 (PDF) – a report recently issued by the Monthly Labor Review, which analyzes trends and circumstances around the fatalities.
Remote Workers Need More Than Cookie-Cutter Safety Strategies – from Risk and Insurance, a discussion on telecommuting workers and an approach to keep them safe.

Health and safety news from the blogosphere

Wednesday, August 26th, 2009

Money-Driven Medicine – Maggie Mahar, one of the regular Health Wonk bloggers who we admire, is author of the book Money driven medicine: the real reason health care costs so much. Her book has been made into a documentary by Alex Gibney, the producer noted for his documentary expo Enron: The Smartest Guys in the Room. This Friday night, Bill Moyers Journal will preview excerpts of Money Driven Medicine, which Moyers cites as one of the strongest documentaries he has seen in years. It bears checking out. For more about the documentary, including a trailer, see moneydrivenmedicine.org. You can also follow Maggie’s blog posts at Health Beat.
Meanwhile, in Business Insurance, Joanne Wojcik writes that two surveys project that healthcare benefit costs will increase by more than 10% in 2010. Aon Consulting projects an average 10.5% increase, while Segal Co. sees cost increases ranging between 10.2% and 10.8% for managed care plans.
Nanoparticles – the NIOSH Science Blog highlights recent research related to occupational disease and nanoparticles. Nanotechnology is the discipline of technology that works at a molecular level with particles that are less than 100 nanometers in size. Earlier this year, the CDC released Approaches to Safe Nanotechnology (PDF), which offers recommendations for specific precautions to protect workers who are exposed to any level of nanoparticles. Learn more about research and risk management at the NIOSH Nanotechnology site.
Fatal SunshineTime recently featured an article on the plight of California farm workers, who frequently do not have adequate protection from heat stroke and basic precautions to prevent heat-related illness. While California state law mandates heat stress standards, many employers do not adhere to those standards. The ACLU and the law firm Munger, Tolles & Olson are suing California’s occupational health and safety agency on behalf of the United Farm Workers, workers who became sick, and relatives of workers who died from heatstroke.
Employer Pandemic Planning – While there are dueling projections for the potential impact of the H1N1 flu this fall and winter, it pays to be prepared. Safety Daily Advisor offers an abbreviated workplace pandemic planning checklist based on CDC recommendations. For more detailed planning information for work and home, see Flu.gov.
More on work suicides – We noted last week that a recent Bureau of Labor Statistics report showed that workplace suicides increased by 28% in 2008. At Comp Time, Roberto Ceniceros looks at the issue of workplace suicide in light of a recent Indiana appeals court ruling in which a widow was denied benefits related to her husband’s suicide.
Taking the job home – Jon Gelman blogs about a recent CDC study showing that workers who are exposed to lead can transport it home. The CDC suggests certain precentive measures to minimize risk to other family members.
Fitness for Duty – Fred Hosier of SafetyNewsAlert posts about how to deal with employees who are consistently unsafe through a comprehensive fitness for duty program.
OSHA – Is OSHA back in the business of enforcement? The Safety Duck thinks that issuance of 142 citations and $576,000 in penalties against Sims Bark Co. and Sims Stone Co. signifies that it is.

News roundup: Health Wonk Review, WC recovery, fatalities, joint & several, AIG and web tools

Friday, August 21st, 2009

Things are sure getting ugly out there in the national debate on health policy. Read what the health policy wonks in the blogosphere have to say about all this – a fresh Health Wonk Review is posted over at David Williams Health Business Blog.
The recovery and WC – Joe Paduda offers an excellent analysis of the likely impact of economic recovery on various segments of the workers comp industry in his post The recovery is coming – what does that mean for work comp? He offers a word of caution for employers: as hiring increases, so too will injuries. “The good folks at the NCCI have looked at the impact of economic recoveries on workers comp, finding “Job creation is related to an increase in the proportion of workers who are inexperienced in their current job and, hence, more likely to sustain a workplace injury.”
Work fatalities down, suicides up – The good news: “A total of 5,071 fatal work injuries were recorded in the U.S. in 2008, down about 10 percent from a total of 5,657 fatal work injuries reported for 2007, according to preliminary government figures.” However, some of the drop is attributed to the economy and a decline in the number of hours worked. Researchers also think that numbers may be lagging since budget constraints at reporting agencies may have delayed classifying cases. One of the most troubling parts of the report is that workplace suicides were up 28 percent to a series high of 251 cases in 2008 – “…the highest number ever reported by the fatality census. Suicides among protective service occupations rose from 14 in 2007 to 25 in 2008.” Read more about the report in Insurance Journal’s story, Fatal Work Injuries Dropped 10% in 2008; Down 20% in Construction.
Joint and Several Liability in action – Roberto Ceniceros blogs about the hefty bills that some New York employers are facing after the demise of self-insured trusts (aka SIGs) in his post Self insuring comp claims has its risks. About 1,789 will be footing about $133 million in unfunded workers comp claims – an average of about $74,000 per employer.
AIG wins one – An NCCI suit alleging that AIG has been shortchanging state workers comp pools for 35 years was dismissed by a federal judge yesterday, but the suit was dismissed on a legal technicality, with no ruling on the actual charges.
Web tools – here are a few good web tools we’ve come across in our travels:
Choose the Best Search for Your Information Need – a guide to some specialty search engines
Wordnik – An ongoing project devoted to discovering all the words and everything about them. We’re liking this, and also recommend our long-term favorite word tool, OneLook.
Meeting ticker – log the number of attendees, enter the average hourly rate, and start your engines. You’ll be surprised to learn how much meetings cost!
ParkWhiz – find and reserve parking before you get there. Enter a date, time & address and get nearby parking garages, rate comparisons, and distance from your destination.
Down for everyone of just me? – enter the address of a website to see if the site is having a widespread problem or if the problem with the page is on your end. It’s surprisingly useful!

Nevada Supreme Court rules suicide compensable

Monday, August 11th, 2008

Is a suicide compensable? In certain circumstances it is, according to a recent ruling by the Nevada Supreme Court in Sharon Vredenburg v. Sedgwick CMA and Flamingo Hilton-Laughlin. While Nevada state law prohibits benefits if a worker’s death occurs due to a “willful intention to injure himself,” this does not apply if a “sufficient chain of causation is established.” Roberto Ceniceros of Business Insurance noted that, “To establish such a chain, claimants must demonstrate that the employee suffered an industrial injury that in turn caused a psychological injury severe enough to override rational judgment. Claimants must then establish that the psychological injury caused the employee to commit suicide, the court said.
Dan Vredenburg was a bartender for the Flamingo Hilton in Laughlin. He suffered back injuries in a fall down stairs while working and was compensated for his injuries. According to the ReviewJournal.com, he suffered relentless pain. He couldn’t keep food down and spent his life in bed. Nealy three years after this accident, he killed himself. Under the state’s “willful intention” clause, his widow was denied benefits several times until the matter reached the Supreme Court and the precedent-setting determination was made.
Other workers comp-suicide rulings: MA, WY, ND
There have been other cases involving suicide where workers comp has been awarded to surviving spouses. This past November, we covered a suicide that was deemed compensable in Massachusetts. In that case, Gilbert Dube injured his back at work. When he tried to return to work on light duty, he was terminated. He then grew depressed and commit suicide a few weeks later. The insurer made the case that his termination was an independent, intervening event that broke the chain of causation. At the hearing, the claimant’s attorney introduced medical evidence that the employee’s back injury caused him to become clinically depressed, and that the termination exacerbated his depression to a degree that he was acting irrationally when he commit suicide. The justices concluded that the injury and termination were inextricably connected.
In the 1992 case of State ex rel. Wyoming Workers’ Compensation Div. v. Ramsey, an Appeals Court upheld benefits for a decedent’s widow using the chain of causation test as the predominating principle in its decision.
Steven R. Ramsey was receiving workers compensation benefits after suffering a severe 1988 industrial accident that left him unable to resume work. In 1990, about 5 weeks after his pain medication was mostly discontinued, his pain increased, he became depressed, and he killed himself. In determining to continue benefits, the Court agreed with his widow:

“The circumstances of this case are clear. Steve Ramsey would not have committed suicide if not for his work place injuries. There were no pre-existing conditions that caused him to be susceptible or prone to suicide, there were not intervening conditions or situations that occurred between the time of his work place injury and his death, and Steve Ramsey continued to do all those things necessary to try and get well. But for the injury at the Wydak Power Plant, Steve Ramsey would not have committed suicide.”

In the same year, a North Dakota Appeals Court denied benefits to the widow of Richard L. Kackman in the wake of his suicide, finding no cause and effect relationship between Richard’s work injuries and his suicide. In this case, two doctors presented conflicting testimony. One doctor concluded that Richard’s work injuries caused chronic illness, which caused depression, which in turn caused him to take his life. The other physician stated that Richard had a prior history of interpersonal problems, delusions, and a paranoid disorder before any work injuries occurred, and those preexisting conditions were what caused Richard to commit suicide. The Court agreed and denied benefits.
These cases show the importance of addressing pain and depression in recovery plans, particularly those involving life-altering injuries. Suicides in workers comp will likely continue to be outliers, but state courts have shown sympathy to the idea that pain and depression can pierce a “willful intention” defense by the insurer. The courts seem consistent from state-to-state in requiring a chain of causation. But despite the precedent-setting nature, we note Jane Ann Morrison’s observation in the Nevada ruling: “None of the lawyers I spoke to thought there would be a rash of suicides by injured workers as a result of this ruling.”