The present study aims to describe a unique case in view of the disease diagnosed, the conditions of onset and the management by INAIL (Italian National Institute of Insurance for Injuries at Work and Occupational Diseases). A worker, after a verbal, animated dispute with some collegues, had an acute psychiatric agitation attack and went to the nearest emergency room, where he was investigated. No neuropsychiatric alteration was diagnosed, but based on anamnestic data, the physicians diagnosed an anxiety crisis reactive to work environment. A medical certificate for injury at work was produced and sent to the Insurance Board (INAIL). The worker was off work for 105 days diagnosed with a persistent anxious depressive syndrome, secondary to the traumatic event. INAIL reassessed the case later and confirmed only the first 30 days as due to work accident, while the following period was judged as related to affectivity disturbance due to common disease, not to work environment. Our case opens new perspective for the occupational physician in the assessment of ASD as work injury and of PTSD as professional disease, suggesting to give more attention to psychiatric health of workers.