Disability

Dealing With The Horrific

More states are offering workers’ comp benefits to first responders suffering from post-traumatic stress.
By: | December 14, 2016 • 7 min read

More and more states are amending their workers’ compensation laws to allow police officers, firefighters and other first responders to file claims for post-traumatic stress disorder triggered by horrific events on the job.

The evidence is scant on how these new laws are impacting both the cost and scope of public sector workers’ comp programs. But virtually everyone agrees that PTSD is a serious issue that departments with first responders must tackle head on.

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Currently, 32 states have laws that permit first responders to file workers’ comp claims for PTSD without accompanying physical claims, and efforts are underway in additional states to similarly amend their workers’ comp laws, according to Norwalk (Conn.) Police Sgt. David Orr.

Orr is president of the Norwalk Police Union, which is lobbying for the State of Connecticut to change its law.

While first responders there can currently file PTSD claims if they witness the death of fellow first responders, there is a push to amend the law so that such claims can be filed after witnessing the death of anyone.

“After Sandy Hook, many of the officers who responded to the school and investigated the aftermath of that devastating tragedy suffered from intense PTSD,” but, he said, “their claims under workers’ comp were rejected by the insurance company and the town.”

“They were forced to go back to work or lose their paychecks, or worse, their jobs. Many did not get the mental health care that they needed.”

In Colorado, unions representing first responders are pushing for changes in that state’s workers’ comp law to delete what they believe is outdated language stating that first responders can only file PTSD claims for traumatic events outside of their usual work experiences, said Longmont (Colo.) Police Sgt. Sean Harper, representing the Colorado Fraternal Order of Police.

Medical Need for PTSD Coverage

Harper said there is medical evidence to support claims that even typical work experiences for first responders can cause extreme distress for some, particularly if the experiences are cumulative.

“As police officers, our job is to protect and serve the community, but we can’t serve at our best if we’re not at our healthiest,” Harper said. “It is in the best interest of the State of Colorado to keep the police as mentally healthy as possible, and that means paying for treatment so these traumatic events do not evolve into PTSD.”

Edie Sonn, vice president, communications and public affairs, Pinnacol

Edie Sonn, vice president, communications and public affairs, Pinnacol

Colorado’s state-chartered workers’ comp carrier Pinnacol Assurance opposed two recent bills in the Colorado legislature, said Edie Sonn, vice president, communications and public affairs.

The Denver-based carrier was concerned about the first bill because it carved out one occupational group, and Pinnacol said the second bill, in the last session, “went too far in the other direction, saying that a claim for mental distress could not be denied based solely on the occupation of the worker.”

“Such a broad approach would create ambiguity in the existing statute and thereby increase litigation,” Sonn said. “We believe there is a middle path between these two extremes to ensure that first responders are covered appropriately.”

Police and firefighter unions in Pennsylvania are also preparing to “push the issue,” said Michael G. Dryden, an attorney at Willig, Williams & Davidson in Philadelphia.

“The laws will make people feel more comfortable getting therapy because their reactions will be treated more as an injury or illness than look like catering to weakness,” Dryden said.

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The cost to workers’ comp programs has yet to be fully measured.

Peter Burton, senior division executive for state relations at National Council on Compensation Insurance in Wayne, Pa., said that many municipalities self-insure for workers’ comp and do not report data to NCCI. Consequently, the organization has little information on claim exposure to price PTSD claims.

“But intuitively, adding this additional compensable injury exposure will likely increase the costs of classifications of municipalities that have first responders, firefighters and EMTs, but not necessarily a significant effect to the entire workers’ compensation system within a particular state,” Burton said.

Workers’ Comp Law Varies

If more states amend their workers’ comp laws, there could be an increase in PTSD claims “due to the apparent availability of an avenue of income without working for those employees so inclined,” said Terri Evans, risk manager for the city of Kingsport, Tenn. and president of the Public Risk Management Association in Alexandria, Va.

Currently, there is no push to change Tennessee’s workers’ comp law.

“In some states, there might be disability benefits and workers’ compensation benefits that would be available to the injured employee at the same time, further enticing disgruntled or unhappy employees,” she said.

Dan Greensweig, assistant director, League of Minnesota Cities, St. Paul, Minn.

Dan Greensweig, assistant director, League of Minnesota Cities, St. Paul, Minn.

“All would depend on how the statute was worded, and what was included or excluded in benefit availability.”

However, Evans stressed that public sector risk managers have a duty to help first responders deal psychologically with traumatic events.

In the City of Kingsport, if an employee feels a work-related incident has impacted them, they can file a claim with the city’s workers’ comp program to determine eligibility of the claim at the onset. That way, even if for some reason the claim is not eligible for workers’ comp, the city can assist the first responder via its employee assistance program, she said.

“We try to be proactive in providing assistance to our employees during times of adversity, whether or not the issue rises to the level of a workers’ compensation claim, because it is important that our employees know they, and their mental and physical health, matter to us,” Evans said.

The Minnesota law that extended workers’ comp coverage for PTSD took effect in October 2013, and so far, the increased cost to public sector workers’ comp programs within the state appears to be “relatively modest” — about 1 percent or so for cities that are members of the League of Minnesota Cities Insurance Trust, said Dan Greensweig, LMCIT’s assistant director at the League of Minnesota Cities in St. Paul, Minn.

The numbers of PTSD claims have been small, about three to five per year, but some of the claims have been very expensive because the individuals needed significant medical care and likely won’t ever be able to return to work as police officers, Greensweig said.

Proactive Counseling

PTSD is “definitely a risk we and our members need to be aware of, not just because of the potential cost implications but also from the standpoint of the public safety officers’ health and well-being,” he said.

“Just as with any other type of injury, the best solution is if we can find ways to prevent the injury in the first place. But of course that’s a challenging thing to do, given the nature of the job for police officers, firefighters, EMTs and other public safety professionals.”

The nonprofit Metro CISM Team in Bloomington, Minn., provides “critical incident stress management teams” throughout the state to help first responders in the aftermath of stressful events, and at least two police departments now require every officer to undergo an annual evaluation that looks for signs of unhealthy levels of stress, Greensweig said.

Ronald F. Meuser, Jr., founder of Meuser Law Office P.A.

Ronald F. Meuser, Jr., founder of Meuser Law Office P.A.

Moreover, LMCIT has paired with Fairview Health Services to offer training to emergency personnel on how to handle situations involving people with mental illness.

“We hope the discussions that result will lead to a greater understanding of mental health issues in general,” he said.

Ronald F. Meuser, Jr., founder of Meuser Law Office P.A. in Eden Prairie, Minn., said that in the hiring process, entities that employ first responders should invest in diagnostic tools such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that will show if someone is suffering from PTSD, depression or anxiety, or indicate whether the person demonstrates a proclivity to developing PTSD in the future.

After first responders experience traumatic events, one-on-one debriefings may be more effective than group debriefings, as first responders may be reluctant to express emotion in front of their co-workers, Meuser said.

First responders should also have yearly psychological check-ups in which they can talk openly and confidentially about any issues, including such taboo issues as recurring nightmares, excessive drinking or moodiness.

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Departments can also be more proactive by looking for changes in a first responder’s demeanor and then referring them for additional help within their EAPs, he said.

For workers who return to work after being involved in violent incidents, risk management programs need to have proactive elements necessary to monitor the workers’ mental recovery, including status check-ins and voluntary counseling services, said Matt Gatewood, a partner at Sutherland Asbill & Brennan LLP in Washington, D.C.

“Achieving the balance of ensuring workers have the necessary means to obtain help while not being too intrusive on the workers’ personal lives is complicated,” Gatewood said. “The most effective programs resist the urge to create a one-size-fits-all approach to this process.” &

Katie Kuehner-Hebert is a freelance writer based in California. She has more than two decades of journalism experience and expertise in financial writing. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]