First Responder Mental Health Lagging in Workers’ Comp

A review of state workers’ compensation laws, published in the Journal of Public Health Policy, reveals that benefits for first responder mental health fall short compared to coverage for physical injury and disease. The analysis highlights the need for state policies to keep pace with the growing recognition of how common mental injury is among first responders and to fulfill the moral obligation to those who provide a critical public health safety net.

While all 50 states provide workers’ compensation coverage for physical-to-mental injuries, the support diminishes when it comes to mental-to-physical (44 states) and mental-to-mental injuries (40 states), according to the report.

Only nine states have enacted presumptions of workplace causation for mental health conditions in first responders. This number pales in comparison to the more common presumption laws for physical conditions, such as cancer (44 states), cardiovascular disease (41 states), and infectious disease (28 states). The lack of presumption laws for mental health conditions places a significant burden on first responders to prove that their psychological injuries are work-related, which can be challenging in the absence of a traumatic physical injury, the report finds.

However, the COVID-19 pandemic has demonstrated that states can implement rapid changes in workers’ compensation when necessary. During the pandemic, 23 states swiftly created presumptions for the virus, showcasing their ability to adapt quickly to protect workers.

Challenges in Proving Workplace Causation for Mental Injury Claims

Proving workplace causation can be difficult in cases that do not involve traumatic physical injury, and this challenging burden generally falls on the claimant. Some states have even increased the burden of proof in mental injury cases, raising the legal standard from “preponderance of the evidence” to “clear and convincing evidence,” per the study.

Several factors complicate the claimant’s burden of proof when it comes to mental injury claims. Latency periods between the workplace stress and onset of the mental condition can make it harder for claimants to definitively link the two. Strict time limits to provide notice of illness to the employer and submit a claim may prevent coverage if the mental injury develops slowly over time.

Pre-existing mental health conditions can also muddy the waters in proving the workplace caused or exacerbated the illness, the report notes. Additionally, some states restrict the specific types of mental health conditions that are covered under workers’ compensation.

The complex chains of causation involved in mental injuries, which may involve cumulative stress over time rather than a single traumatic event, present challenges in meeting the burden of proof. Unlike a broken bone or occupational disease with a clear physiological cause, the etiology of mental conditions is often multifaceted and more difficult to conclusively trace to the workplace. This puts the onus on the claimant to demonstrate the work-related factors were the predominant cause of their mental injury.

Implications and Recommendations

Failing to adequately compensate first responders for workplace-induced harm to their mental health can have far-reaching negative consequences.

When mental health conditions go untreated, it can lead to inflated medical costs, increased absenteeism and resignations, and contribute to the stigma often attached to mental illness. As the study notes, “Failure to integrate mental and physical health may cost the workers’ compensation systems billions of dollars annually.”

To address this issue, state decision-makers can create presumptions that mental health conditions in first responders are caused or significantly exacerbated by their stressful workplaces, according to the report. This would ease the burden of proof on claimants and ensure that more first responders receive the support they need. The alternative — losing these essential workers to total disability — can be far more costly in the long run, according to the study.

Download the full study here. &