Policy Matters


  • States’ push for PTSD coverage triggers concerns over future treatment impact

    Workers’ compensation coverage for first responders has been a popular topic in recent years. Numerous states have debated or discussed policies which either expand or create new coverage, or approve treating conditions previously not considered compensable.

    We have seen states move forward with coverage for various types of cancer for firefighters and provide greater coverage for cardiovascular conditions more frequent in police officers.

    Currently, most legislative efforts are evaluating expanding coverage to treat Post Traumatic Stress Disorder (PTSD) for all first responders. PTSD, a mental health condition often triggered by a traumatic event or continued exposure to high levels of stress or traumatic events, is gaining interest in the first responder community. Police officers, firefighters and paramedics are often exposed to high stress level situations or traumatic events during the course of their employment. 

    Several states address PTSD coverage
    By late June 2019, over 21 state legislatures examined or debated providing PTSD coverage for first responders, with several states passing final legislation making PTSD a covered condition. Idaho, Mississippi, New Hampshire, Oregon, South Carolina and Texas all passed legislation to either modify the existing list of covered conditions for first responders, or add a new definition or coverage of PTSD as a work-related injury or illness compensable under existing state workers’ comp laws. 

    New type of care creates future uncertainties for employers and payers
    Many in the first responder community welcome the attention to the issue of PTSD and expanded work comp-related coverage, while some in state and municipal governments remain concerned about future costs for the expanded coverage. The addition of PTSD for this select group of government employees introduces a new area of care which is less focused on physical treatment, the traditional type of workers’ comp care, and more focused on mental health treatment of the claimant. 

    Clinical perspective
    PTSD can cause dramatic and devastating effects, and the most beneficial treatment involves a fully-developed and multidisciplinary approach. Medications (most commonly antidepressants) and psychological therapy or counseling, such as cognitive behavioral therapy, are often required. As with other complex medical conditions, it is important to remember the key is providing a synergistic course of treatment that keeps the injured worker at the center of the claim.

    What’s next?
    While the complex issues and concerns are vetted during legislative debates, states continue to expand or include PTSD as a compensable condition. This expansion is beneficial for our first responders who suffer, but brings new challenges to workers’ compensation stakeholders.  As these expansions continue, OWCA urges clients who provide coverage for first responders to learn more about the condition, as well as the treatments and various medications which are commonly utilized to treat PTSD. 

    Should you have questions on this or any other policy, please contact our Government Affairs team at AskGovtAffairs@optum.com



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