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States weigh comp reforms for first responders with PTSD

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PTSD

Legislative efforts to make it easier for first responders to receive workers compensation benefits for mental stress injuries, such as post-traumatic stress disorder, have cropped up in several states with varying degrees of success this year.

In Colorado, a bill that would expand state law to clarify the definition of a “psychologically traumatic event” and “serious bodily injury” under workers comp passed the state Senate 28-6 last week.

“The problem was that when these first responders would seek out professional help to treat their PTSD they received on the job, paying for the treatment had to come out of their pockets,” according to a statement issued by the Colorado Senate Democrats.

Earlier this month, Vermont’s House of Representatives passed a presumption bill that would provide comp benefits to first responders who suffer from PTSD resulting from on-the-job experiences. The bill limits claims to injuries that occur within three years of the last active date of employment and would disallow PTSD claims for triggering events that can be proved to be non-occupational.

Florida, where first responder PTSD issues are in the spotlight after an Orlando police officer said he suffers from PTSD for his role in responding to the Orlando nightclub shooting in June 2016, also is considering making treatment for PTSD more accessible under its workers comp system via two bills introduced earlier this year. Senate Bill 516 would amend an existing law that has barred police and firefighters from claiming mental injuries under workers comp. The bill states that a mental injury must be “demonstrated by clear and convincing medical evidence” and must be connected to a specific incident.

An alternative bill, Senate Bill 1088, would provide workers comp for Florida firefighters, paramedics, emergency medical technicians and law enforcement officers who suffer a mental injury — regardless of whether they have an accompanying physical injury — and have a “preponderance” of evidence showing the mental injury arose out of their work, according to a copy of the bill posted online. The legislation would also provide survivor benefits to family members if the mental injury results in the death of the first responder.

New York included first responder PTSD language in its 2017-18 state budget. The rule prevents the  New York State Workers’ Compensation Board from disallowing a first responder’s claim for mental injury based on extraordinary work-related stress incurred if the stress is found to be not greater than that which usually occurs in the normal work environment.

These bills are important not only for providing access to services that first responders might need, but also for reducing the stigma around seeking treatment for mental health issues, said Jim Brinkley, director of occupational health and safety at the Washington-based International Association of Fire Fighters. First responders are typically conditioned to filling the role of helping others, he said, and that can make it difficult for them to ask for help when they need it.

“When you have something that’s not even covered, whether in workers comp legislation or as a health care benefit, it almost sends the message that this is something that is abnormal and shouldn’t be part of our lexicon,” Mr. Brinkley said. “Having it covered as something that is job-related tells us them this is something they can expect to experience because others have as well, and if you do need access to the services, you’re not abnormal.”

One in five firefighters or paramedics will suffer from PTSD at some point in their career, according to the association. Those figures may seem daunting for the workers comp system in terms of a potential cost burden, but Mr. Brinkley said most mental stress injuries don’t require extensive treatment or lost work time and don’t lead to a major cost impact on the workers comp systems.

Providing counseling or other treatments under workers comp can help return first responders to work more quickly and prevent long-term issues and forced retirements, he said.

Advocates for employers and insurers are cautious about first responder PTSD bills, saying they should be carefully crafted to provide reasonable limits and evidence-based standards to avoid subjective claims.

“We can certainly appreciate and understand the efforts that first responders are making, but we would caution against expanding legislation without limitation unless there are reasonable restrictions when applied to other workers,” said Steve Bennett, associate general counsel and director of workers comp programs at the Washington-based American Insurance Association.

The Washington-based Self-Insurance Institute of America Inc. has been monitoring presumption bills for both physical and mental first responder injuries and is encouraging rules that limit coverage only to injuries that can be connected to on-the-job events.

“The benefits need to be reasonable and directly related to work, and you have to go into the fine details to ensure you don’t leave your funds at greater risk of exposure and possible insolvency,” said Adam Brackemyre, vice president of state government relations at the institute. “It’s a careful balance.”

Mr. Brackemyre said he expects PTSD bills to continue to be a trend for the next couple of years.

“There’s a need for that type of medical treatment, but it’s a matter of how to make it work under workers compensation,” he said. “If it doesn’t exist now you want to make sure you have time to build a provider network and negotiate prices on the medical side, because that becomes a very expensive benefit to provide.”