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Four states in the first week of February introduced or moved forward on workers compensation presumption bills that would make post-traumatic stress disorder and other mental ailments compensable for first responders, in a continuation of a years-long legislative trend.
According to a 2021 paper by service provider Optum Workers’ Comp and Auto No-Fault, more than 50% of states have enacted PTSD policies or policy changes since 2018. Many new laws passed in recent years have followed major emergencies and tragedies that triggered legislatures to act. The COVID-19 pandemic is shaping up to be no different.
“With COVID, people are more amenable to the idea that mental injuries are a problem than (they have been) in the past,” said Tom Howard, an attorney at workers compensation firm Gerber & Holder LLP in Atlanta.
Opponents of such legislation have claimed that the presumptions are or could be costly, with virtually every first responder representing a potential claim. Proponents, meanwhile, say the presumptions are much needed to fill the gap created when first responders face mental illness.
H.B. 3899 in Oklahoma and H.B. 274 in Alabama aim to provide PTSD and other mental injury coverage for first responders, while H.B. 689 in Florida would amend existing statutes to provide first responders more time to file such claims.
This follows the 2021 legislative season, when at least half a dozen states introduced bills with mixed results, according to the Optum report.
Florida, which has had a presumption in place since 2018, is among the first to publicly release data on costs. Since expanding workers comp coverage for mental health costs, the state has paid out approximately 50 claims for $2.1 million total, or $42,330 per claim, according to the Department of Financial Services.
A National Council on Compensation Insurance study of mental health claims for first responder classes found the group accounted for approximately 1.6% of privately insured costs for mental treatment, with most states showing a range of 0.5% to 3.0%.
Bruce Spidell, NCCI’s actuarial committee liaison, said that based on the study findings he believes legislation focusing on first responders may have a relatively small impact on overall workers comp costs.
Rep. Gregg Kennard, who is sponsoring H.B. 855 in Georgia, said the cost of the bill would be $3 million to cover 33,650 first responders, according to the Georgia House Budget & Research Office.
The Georgia bill has received significant public attention and support based on one police officer’s experience and lobbying efforts. Gwinnett County police officer Ashley Wilson was on duty in 2018 when her partner was shot and killed.
“I stayed with him the whole time, from the scene to the trauma room to the medical examiner's office to the funeral till we buried him in California,” she recalled.
Ms. Wilson developed PTSD and began medical treatment in the months after the shooting. She said she returned to work “happy and healthy” but with $20,000 in medical debt —entirely out of pocket. She discovered at least some of the coverage she needed was available in other states and later turned to the legislature for help.
“It started gaining support quite quickly because, unfortunately, suicide is not uncommon or a surprising factor in our communities,” she said.
Multiple studies in recent years have confirmed that suicide rates among emergency medical workers are significantly higher than those of the general public. And, according to a Ruderman Family Foundation report, law enforcement officers and firefighters are more likely to die by suicide than in the line of duty. It’s estimated 30% of first responders develop behavioral health conditions, compared with 20% in the general population, according to the Substance Abuse and Mental Health Services Administration.
A 2016 study cited by SAMHSA found 37% of fire department first responders have considered suicide – a rate 10 times higher than the national average. Additionally, the study found 6.6% of fire and EMS professionals reported having attempted suicide, as compared with just 0.5% of civilians.
RAND Corp. researchers, however, found that firefighters and peace officers do not appear to have worse mental health or higher suicide rates than other workers exposed to trauma on the job, though lack of data prevented RAND researchers from directly measuring the incidence of PTSD, according to a 2021 paper by the think tank.
Opponents have also raised concerns of “how easy it is to give a diagnosis in the mental health realm,” Mr. Howard said.
Rep. Kennard countered this idea, citing a second bill, S.B. 342, pending in the Georgia Senate, which would establish the Mental Health Parity Act.
“Trained professionals can certainly ascertain if there's been some connection between the job performed and any psychological injury,” he said. With this bill medical health injuries would be treated the same as physical injuries, “which means it has to go through the same thresholds of proof,” he said.
Virtually every PTSD bill nationwide has included parameters for diagnoses, all requiring documentation from a medical provider who can verify the symptoms of PTSD.