Can PTSD be an L&I claim?
PTSD arising from one incident (injury) can be a successful L&I claim for all occupations.
PTSD arising from the accumulation of several or many incidents (occupational disease) can be a successful L&I claim only for first responders.
There is a New Law in Washington State, RCW 51.08.142. Now first responders can file a successful PTSD claim for the effects of CUMULATIVE trauma.
The old law did not allow PTSD claims which were based on cumulative psychological traumas (occupational disease) that occur over time which combine to cause severe mental problems. This old law is still in effect for all occupations in Washington State, except first responders.
The new law is a fix to the old law and exempts certain firefighters, emergency medical technicians (EMT’s), and law enforcement officers from the old L&I rule.
Want to Understand the New PTSD First Responder Law?
Then understand the difference between injury and occupational disease.
- L&I classifies all on the job claims as either an injury or an occupational disease. It makes a big difference which type of L&I claim you have, injury or occupational disease.
- AN INJURY is a one-time event occurring suddenly and traumatically. For example, falling off scaffolding and breaking your arm is an injury. For further details see L&I Claims are Either an Injury or an Occupational Disease.
- AN OCCUPATIONAL DISEASE is different than an injury. An occupational disease develops over time. For a detailed definition see L&I Claims are Either an Injury or an Occupational Disease An example of an occupational disease is a painter who breathes toxic chemical every day and develops asthma. The painter’s asthma is an occupational disease because it developed over an extended period of time and it arises naturally & proximately out of employment.
- There is a profound legal and factual difference between injury and occupational disease. A traumatized worker in Washington State should choose their words carefully. They must understand what has happened to them and then clearly say what they mean when describing their history of job incident(s). A worker needs to say the right thing to the doctor about how their condition has developed. Once the medical history is written into the records it determines how the claim will be looked at. Understand the impact of what you are saying before you talk with your doctor.
Want to Be Helped by the New First Responder PTSD Law?
The new law allows cumulative trauma L&I PTSD claims resulting from post traumatic stress disorders for MOST FIRST RESPONDERS, (but not other occupations).
This means that first responders can now file and be successful with a cumulative trauma (occupational disease) PTSD claim. RCW 51.08.142
The new law goes much further. It creates a prima facie rebuttable presumption that PTSD for first responders is an occupational disease. RCW 51.32.185
This rebuttable presumption is a huge benefit to first responders. Proof of an occupational disease has previously been the expensive and difficult part of the claim. This new law for first responders is very helpful because it does not just allow a cumulative PTSD claim, it also makes it easier to prove that cumulative trauma PTSD is job related. This easing of the proof requirement is done with a rebuttable presumption.
What is Rebuttable Presumption?
The new law for first responders creates a rebuttable presumption that PTSD is an occupational disease. This rebuttable presumption is a legal procedural rule designed to assist L&I claimants when they are proving a claim. As it applies to this new law, and subject to the limitations listed below, claims of first responders based on mental conditions or mental disabilities caused by stress will now be presumed to be work related, unless proven otherwise.
Why is This Presumption Helpful?
- As the law was previously written, without a presumption, a first responder had to prove both their PTSD diagnosis and that it was more likely than not caused by their employment. This proof requirement is expensive.
- Under the new law, the first responder first shows they have PTSD, and then this medical condition will be presumed to be a job related occupational disease. If the employer chooses to fight the claim, the employer will have to prove that there is no PTSD or that the PTSD is not job related.
- Said another way this legal presumption is helpful because first responders’ PTSD claims will now be easier to prove.
Important Details Limit the Scope of this New Legislation
- PTSD means a disorder that meets the diagnostic criteria for post-traumatic stress specified by the American Psychiatric Association in the Diagnostic and Statistics Manual of Mental Disorders, Fifth Edition, or in a later edition as adopted by L&I rule RCW 51.08.165.
- The cause of the PTSD is important. Even under the new law, PTSD for first responders is excluded as an occupational disease if the condition is directly related to disciplinary action, work evaluations, job transfer, layoff, demotion, or termination taken in good faith by the employer.
- For the rebuttable presumption to apply, PTSD must develop after the individual has served at least 10 years. This section appears to nevertheless allow the first responders PTSD to be a valid occupational disease, only without the helpful presumption.
- For the rebuttable presumption to apply to workers hired after the effective date of the legislation, that worker must, at the time of hire, submit to an employer sponsored exam which rules out PTSD. If no exam is provided by the employer, then there is no corresponding requirement.
- The presumptions shall be extended to members after termination of service. See RCW 51.32.185(2).
- The presumption may be rebutted by a preponderance of the evidence.
Who Qualifies as a First Responder for the New Law?
- A first responder is a-
- Firefighter – as defined in RCW 41.26.030 (17) (a) (b) (c).
(a) Any person who is serving on a full time, fully compensated basis as a member of a fire department of an employer and who is serving in a position which requires passing a civil service examination for firefighter, and who is actively employed as such;
(b) Anyone who is actively employed as a full time firefighter where the fire department does not have a civil service examination;
(c) Supervisory firefighter personnel;
- Emergency Medical Technician (EMT) – as defined in RCW 41.26.030(17) (h)
Any person who is employed on a full-time, fully compensated basis by an employer as an emergency medical technician that meets the requirements of RCW 18.71.200 or 18.73.030(12), and whose duties include providing emergency medical services as defined in RCW 18.73.030.
- Law Enforcement Officer – as defined by RCW 41.26.030(19)
- Any person who is commissioned and employed by an employer full time, fully compensated basis to enforce the criminal laws of the state of Washington generally, with some exceptions
Do I Need a Lawyer to Help with My PTSD Claim?
Many claims can be handled without a lawyer. It helps to understand and pay attention to what is written here. Your medical records will define and limit the success of your claim. Be honest, precise, and careful what you say to a doctor, or triage nurse when they have a pen in their hand.
The Old PTSD Rule
- No PTSD claim for cumulative trauma because of the L&I rule, that claims based on mental conditions or mental disabilities caused by stress do not fall within the definition of Occupational Disease. RCW 51.08.142
- However, injury PTSD resulting from a single traumatic event can be an allowable L&I PTSD injury claim.
- A series of minor traumatic events is not an allowable L&I PTSD occupational disease.
- A single traumatic event of sufficient magnitude, that occurs within a series of minor traumatic events, is allowable as a PTSD injury.
Old and Current L&I Injury Law – (for everyone)
The Law for all claims (first responders and everyone else too) is that PTSD caused by one stressful event can be allowed as an L&I injury. RCW 51.08.100 and WAC 296-14-300. A onetime mental event, or one significant mental event in a series of events, is an allowable injury. For example, a first responder who has a person die in their arms. They then develop PTSD. They will have an allowable L&I injury PTSD claim, subject to these guidelines:
“As an injury, stress resulting from exposure to a single traumatic event, such as actual or threatened death, actual or threatened physical assault, actual or threatened sexual assault, and life-threatening traumatic injury, may be considered an industrial injury. These exposures must occur in one of the following ways:
- directly experiencing the event
- witnessing, in person, the event as it occurred to others or
- extreme exposure to aversive details of the event.”
Old and Current Occupational Disease Law – (for everyone Except first responders)
- No PTSD claim for cumulative trauma because of the L&I rule, that claims based on mental conditions or mental disabilities caused by stress do not fall within the definition of Occupational Disease. RCW 51.05.142 (1)
Confused? It goes with the the territory. L&I occupational disease law is confusing. These cases can be won. Call for help if you need it.
Why Do First Responders Get a Special Law That Applies Only to Them?
First responders do the heavy lifting in the world of human tragedy. Every time they scrape up another lifeless body from a tragic accident, some of that tragedy rubs off on them. Every time they rescue and console a burned-out family who has lost everything, it chokes them up too. Each time they risk their lives to restore law and order, their life thereafter is affected by that. Over time these extreme stressful experiences add to the memories of first responders. No matter how they try to remain in control and unattached, the cumulative experiences frequently overcome even the most seasoned first responders. Eventually, sometimes after decades of service, a first responder will break emotionally from the cumulative stresses.
First responders pay a price for what they do. The price they pay is on the job PTSD. They deserve L&I benefits and now they can get those benefits.
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