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Where Workers’ Comp Can Do Better for First Responders

Including first responder mental health coverage in workers’ compensation calls for a shift in the definitions of a workplace injury and compensable treatment.
By: | August 10, 2017

In 2012, police officers and paramedics were called to Sandy Hook Elementary School in response to a shooting that took the lives of 28 people, mostly children. In 2015, chaos erupted at an office holiday party in San Bernardino when a gunman and his wife opened fire on his colleagues. In 2016, first responders converged on Pulse nightclub in Orlando to stop a shooter who cornered many of his victims inside.

Those are perhaps the most newsworthy stories of violence and terror that have gripped the American psyche in recent years, but similar scenes have occurred in a total of 40 states across the country.

In their wake, first responders who see the carnage firsthand are left to grapple with the psychological ramifications of tragedy.

“States are seeing how these traumatic events impact first responders and are starting to ask, how can we help the people that we send into these horrible situations?” said Danielle Jaffee, Manager of Government Affairs, IWP. “The problem is that existing workers’ compensation statutes were not written to accommodate first responders specifically, or mental health claims in general.”

Including first responder mental health coverage in workers’ compensation calls for a shift in how state legislatures define a workplace injury, and how they think about compensable treatment.

Legislative Challenges

Danielle Jaffee, Manager of Government Affairs

States fall into one of two buckets: first, there are the states that require a physical injury to be attached to a workers’ comp claim. For those states, redefining what qualifies as an injury will be the biggest obstacle in incorporating mental health care into workers’ compensation.

“In many states, a physical component is a requirement to file a workers’ comp claim,” Jaffee said. “If you have a broken bone, we can clearly see that on an X-ray, we know it needs a cast, and we know it will take about eight weeks to heal.”

Intangible mental injuries like post-traumatic stress disorder cannot always be objectively and definitively identified, and the treatment plans are less clear-cut. Allowing workers’ comp claims for this type of injury introduces uncertainty that not all lawmakers are comfortable with.

“We don’t know how many people will file a claim, how long they will need care for, and what the cost will add up to,” Jaffee said. “And of course no one can predict when the next traumatic incident will occur or what its scale could be.”

And when the claimants are publicly-employed first responders, the burden of paying for care falls on the shoulders of cities, towns and municipalities — entities often saddled with very limited budgets. The combination of claim unpredictability and potentially unaffordable care is what keeps many states from getting legislative measures passed.

“Discussions in those states are centered on the best way to add mental health care to workers’ comp without a physical injury, so that they can take care of first responders without overtaxing the system,” Jaffee said.

Then there are states that fall into the second bucket: those that do allow workers’ comp claims for mental health injuries, but stipulate that the event that triggered the claim must be outside of the normal scope of the claimant’s work.

“That would automatically exclude first responders,” Jaffee said. “Being in dangerous and traumatic situations naturally falls within their job descriptions.”

So for these states, the question at the center of the debate is: who should get coverage?

If they remove the exclusion that the triggering event must be out of the ordinary, every employee in the state could reasonably find grounds to file a mental health claim, which increases the likelihood of fraud and the cost that comes with it.

“Everyone experiences stress at work — but everyday stresses cannot be the basis of a workers’ comp claim,” Jaffee said. “Statutes need to include language that specifies mental health coverage — without a physical component — that applies only to first responders. This will help to contain the claims.”

State of the States

Despite the legislative challenges, the need to care for first responders’ mental health is no longer something states can push aside. Our 24/7 news cycle that readily broadcasts the aftermath of violence and disaster, combined with increased awareness around PTSD and mental health in general, have spurred efforts to make an old system work for a modern day problem.

“Since 2012, we’ve seen 10 to 15 states examining ways to help our first responders amid an increase of PTSD claims,” Jaffee said. “Connecticut really lead the charge after the Sandy Hook shooting brought this issue to the forefront.”

But five years later, Connecticut is still trying to find a way to make it work. A bill that would include coverage for PTSD when a first responder witnesses the death or aftermath of death in the line of duty, regularly fails to pass out of the legislature.

Florida, Texas, Maine, Colorado, Minnesota, California and Vermont are among others examining the issue. Florida introduced legislation this year to allow claims of mental health ailments without a physical injury, and Texas proposed a bill to presume that PTSD in first responders was related to their job, provided it was not diagnosed earlier.  In Ohio, though no bill is in the works, police officers have been lobbying for years to have mental health care provided by the workers’ comp system.

“They are recognizing the need for this care among their members,” Jaffee said. “But it is a unique problem for each state because the language of workers’ comp statutes varies across the country.”

Advocating for Change

As the “patient advocate pharmacy,” IWP tracks the regulatory and legislative updates across all 50 states and engages with lawmakers, insurers, physicians and patients to bring discussion around the issue into the spotlight and keep the conversation going.

“Seven to eight percent of American adults, or roughly eight million people, will have PTSD in their lifetime,” Jaffee said. “We’ve seen the need for mental health care among our patients and asked ourselves, ‘is this an injury we can help to heal?’”

Jaffee and the rest of the Government Affairs team at IWP aim to educate workers’ comp stakeholders through face-to-face meetings and informational whitepapers. They also work to afford injured workers a voice by weighing in on proposed legislation through public comments.

“We’re trying to spark the conversation around the mental health care needs of first responders, because doing so will ultimately help them gain access to the services they need to go back to work,” Jaffee said. “We support efforts that states are making to work through a complicated issue to better serve their workers.”

To learn more, visit https://www.iwpharmacy.com/.

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This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with IWP. The editorial staff of Risk & Insurance had no role in its preparation.




IWP is a national home delivery pharmacy service working as an advocate for injured individuals. Fully licensed in 48 states, IWP enhances patient access and alleviates administrative and financial burdens.

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