More than 40 years after the American Psychological Association first included post-traumatic stress disorder in its manual for health care practitioners, the medical condition is becoming a source of increasing concern in the workers compensation sector.

In earlier eras, and under different names, PTSD was most closely associated with the exposure of military personnel to violence during combat, such as soldiers suffering from “shellshock” during World War I. And often sufferers toiled with untreated symptoms for years.

Now, PTSD is recognized as a mental injury that is suffered by many more people — often first responders but also victims of violent attacks and others — and one that can be sustained in a wide variety of situations, including in the workplace.

As recognition of the condition has grown, treatment protocols have evolved to the extent that many medical professionals view PTSD as a condition that can be effectively treated. As we report here, talk therapy, medication and technological tools are all used to treat PTSD.

Relatively few people suffer from PTSD — about 6% of the U.S. population will suffer from the condition at some point during their lives — but the number of people in the workers comp system that are treated for PTSD has grown and is likely to grow further. That’s because an increasing number of states are introducing and sometimes passing legislation that would extend PTSD presumptions to a wider group of workers, beyond the usual categories such as cops and firefighters. For example, Connecticut last year extended its presumption law to all workers who witness harrowing events, and Washington added nurses to its category of workers.

But many of the proposed presumptions have not made it through the various legislatures. Notably, in California Gov. Gavin Newsom vetoed a bill that would have expanded the state’s PTSD presumption to various nurses and other medical staff. In his veto message, the governor noted the “proven difficulty of establishing a direct relationship between a disease or injury and the employee’s work.”

Therein lies the rub, when you have different systems that are tapped to treat a medical condition that is difficult to conclusively prove is tied to a discrete cause — should PTSD treatment be paid for through workers comp, employee medical benefits or another program?

In cases where states conclude they have sufficient evidence to link medical conditions to certain occupations, there’s no getting around the financial consequences for employers and workers comp insurers. 

Of course, most PTSD presumption bills pending in state houses are well intended, but lawmakers must consider all the implications of expansion provisions and base their decisions on scientific analysis before approving measures that will have far-reaching consequences for many employers.