Workers’ Compensation Faces Wave of Mental Health, Cancer Coverage Expansions in 2025

NCCI tracks 950 bills nationwide as states expand presumptions for first responders while grappling with gig economy classifications and marijuana reimbursement.
By: | September 29, 2025
legislation

With 164 workers’ compensation bills already enacted out of 950 being monitored nationwide as of July 31, 2025, states are rapidly expanding workers’ compensation coverage for mental health conditions and cancer among first responders while wrestling with emerging challenges around worker classification and medical marijuana reimbursement, according to NCCI’s 2025 Legislative and Regulatory Trends Report.

The push to cover post-traumatic stress disorder (PTSD) and other psychological injuries for first responders continues to dominate state legislative agendas, the NCCI reported. Seven states are considering new PTSD coverage laws, with Illinois, New York, and Texas proposing rebuttable presumptions of compensability. Nevada and Tennessee have already enacted expansions this year, with Tennessee creating a presumption that PTSD diagnoses for law enforcement and emergency medical responders were incurred in the line of duty.

Beyond first responders, states are broadening mental health protections to other worker categories. Connecticut considered legislation that would expand qualifying events to include witnessing non-fatal injuries, while multiple states proposed extending coverage to educators, healthcare workers, and even all employees in some jurisdictions.

Cancer presumptions for firefighters represent another major expansion area, the NCCI noted. Utah enacted comprehensive legislation listing 15 specific cancers as presumptive for firefighters while requiring cancer screenings. Virginia added throat cancers to its existing presumptions, and California is considering extending cancer presumptions to firefighters at commercial airports and federal installations. Nevada and Wyoming implemented new cancer screening requirements for firefighters as preventive measures.

Worker Classification and Substance Reimbursement Create New Complexities

The ongoing debate over independent contractor versus employee status intensified in 2025, with Arkansas and Texas enacting new definitions while multiple states grapple with exemptions for specific industries, according to the NCCI report. California alone is considering exemptions for manicurists, commercial fishers, athletic coaches, and construction truckers from its stringent “ABC” test for worker classification. The gig economy remains a particular focus, with states divided on whether delivery network and transportation network company drivers should be classified as independent contractors.

Medical marijuana reimbursement continues to challenge the workers’ compensation system as more states legalize cannabis while federal prohibition remains, according to the report. Several states proposing marijuana legalization explicitly exclude workers’ compensation reimbursement requirements, including Idaho, North Carolina, and Tennessee. Conversely, New York and Massachusetts are considering mandatory reimbursement for medical marijuana as a prescribed treatment.

The emergence of psychedelic therapies adds another layer of complexity, the report added. Colorado enacted legislation to legalize prescription psilocybin upon FDA approval, while New Mexico authorized psilocybin use for qualified medical conditions. Multiple states are studying psychedelic-assisted therapy programs, though most proposals specifically exclude workers’ compensation reimbursement requirements.

Emerging Risks Signal Future Challenges for Risk Managers

Several developing trends suggest new frontiers for workers’ compensation coverage, according to the NCCI report. Alternative insurance arrangements outside traditional workers’ compensation systems are gaining traction, with Alabama creating a separate compensation board for educators and Florida considering occupational injury benefit plans for certain employers.

Climate-related concerns are materializing through proposed heat-injury presumptions, particularly for agricultural workers in California. Federal legislation would study the economic impact of extreme heat events, signaling potential nationwide attention to temperature-related workplace injuries.

Artificial intelligence regulation affecting claims processing, utilization review, and prior authorization represents another emerging challenge for workers’ comp, the report said. States are increasingly focused on AI transparency, discrimination prevention, and governance guidelines that could reshape how workers’ compensation insurers operate.

Workplace violence prevention programs are also gaining legislative attention, with states considering mandatory violence prevention plans and studying the prevalence of workplace violence incidents. These initiatives suggest potential future expansions of employer liability and coverage requirements.

Obtain the full NCCI report here. &

The R&I Editorial Team can be reached at [email protected].

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