Can PTSD be claimed through workers’ compensation?
Yes, PTSD can be a successful L&I claim. The type of L&I claim to file for PTSD will depend on the occupation of the worker. A post-traumatic stress disorder claim arising from a single incident can be a successful workers’ compensation injury claim for all occupations. Whereas only first responders can make a successful workers’ compensation claim for PTSD arising from the accumulation of several or many incidents (as an occupational disease).
What is PTSD?
Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced witnessed or been exposed to extreme adverse details of a traumatic event, series of events or set of circumstances. Individual symptoms may affect mental, physical, social, and/or spiritual well-being. Information for patients and families on PTSD
What is the new PTSD law for first responders?
Recently, however, RCW 51.08.142 was fixed to allow first responders to file a successful workers’ compensation claim for PTSD for the effects of CUMULATIVE trauma.
While the old law did not allow PTSD claims which were based on cumulative psychological traumas (occupational disease) that occur over time and combine to cause severe mental problems, the new law exempts certain firefighters, emergency medical technicians (EMTs), law enforcement officers, public safety telecommunicators, and direct care registered nurses from the old L&I rule.
That said, the old law is still in effect for all other occupations in Washington State apart from first responders.
Understanding the New PTSD First Responder Law
To understand the new PTSD first responder law, you must understand the difference between injury and occupational disease. L&I classifies all on-the-job claims within these two categories, and the profound legal and factual differences between each will impact the outcome of your workers’ compensation claim.
Injury – an injury is a one-time event occurring suddenly and traumatically. For example, falling off scaffolding and breaking your arm is an injury.
Occupational Disease – an occupational disease develops over time. An example of an occupational disease is a painter who breathes toxic chemicals daily and develops asthma. The painter’s asthma is an occupational disease because it evolved over an extended period, and it arises naturally & proximately out of employment.
If a traumatized worker wishes to be classified correctly in Washington State, they must choose their words carefully and understand the impact of what they say before talking with their doctor or mental health professional. A worker needs to say the right thing to the doctor about how their condition has developed because their recorded medical history will determine how the claim will be looked at. To do so, they must understand the medical and legal impact of their words and then describe their history of job incident(s) as clearly and concisely as possible.
Important PTSD Considerations
When trying to decide if you have a good PTSD claim, understand that these occupational disease rules address the issues of:
- will this employment situation be one that can be covered as an occupational disease?
- will this employment allow the application of the helpful presumption?
What was the OLD PTSD LAW for first responders?
According to the old PTSD law, first responders and everybody else were not allowed to collect workers’ compensation benefits for post-traumatic stress disorder resulting from cumulative trauma because of the L&I rule that claims based on mental health conditions or 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 could have been an allowable workers’ compensation claim for PTSD injury.
Under the old law, a series of minor traumatic events is not an acceptable L&I PTSD occupational disease. Whereas a single traumatic event of sufficient magnitude that occurs within a series of minor traumatic events is allowable as a post-traumatic stress disorder injury.
How can the new PTSD law help first responders?
The new law allows cumulative trauma workers’ compensation PTSD claims to result from post-traumatic stress disorders for MOST FIRST RESPONDERS.
This means that first responders can now file and be successful with a cumulative trauma (occupational disease) PTSD claim under RCW 51.08.142. However, the new law also goes much further by creating a prima facie rebuttable presumption that PTSD for first responders is an occupational disease, as per RCW 51.32.185.
This rebuttable presumption greatly benefits first responders because it does not just allow a cumulative PTSD claim. It also makes it easier to prove that cumulative trauma PTSD is job-related. Historically, proving the relationship of the occupational disease to the job has been the expensive and challenging part of the claim. This easing of the proof requirement is done with a rebuttable presumption.
What is a rebuttable presumption?
The new law for first responders creates a rebuttable presumption that post-traumatic stress disorder is an occupational disease. This rebuttable presumption is a legal procedural rule designed to assist workers’ compensation claimants when 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 disabilities caused by stress will now be presumed work-related unless proven otherwise.
Why is this presumption helpful?
As the law was previously written, without a presumption, a first responder had to undergo an expensive process to prove both their PTSD diagnosis and that their employment likely caused it.
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.
Additionally, when a determination involving these presumptions is appealed by L&I or the employer to the Board of Industrial Insurance Appeals (BIIA) or litigated in any court, and the final decision allows the claim, L&I or the employer must pay all reasonable costs of the appeal to the worker or their beneficiary, including attorney and witness fees.
Essential Details That Limit the Scope of this New Legislation
Here are some other essential details that first responders must understand regarding 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, according to RCW 51.08.165.
- The cause of 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. See WAC 296-14-300 (1) for a long list of exclusions.
- For the rebuttable presumption to apply, PTSD must develop after the individual has served a specified amount of time. This section appears to allow the first responder’s 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 that rules out PTSD. If the employer provides no exam, then there is no corresponding requirement. If an exam is provided and there is no pre-employment PTSD or no pre-employment PTSD then present, the presumption arguably applies.
- The presumptions shall be extended to members after termination of service, according to RCW 51.32.185 (2).
- A preponderance of the evidence may rebut the presumption.
Who qualifies as a first responder under the new law?
A first responder for L&I purposes is a firefighter, EMT, law enforcement officer, public safety telecommunicator, or direct care registered nurse.
Firefighters, as defined by RCW 41.26.030 (17) (a) (b) (c), include:
- 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;
- Anyone who is actively employed as a full-time firefighter where the fire department does not have a civil service examination;
- Supervisory firefighter personnel
- Firefighters are first responders. They benefit from the helpful PTSD rules.
Emergency Medical Technicians (EMTs)
- Emergency Medical Technicians (EMTs), as defined by RCW 41.26.030 (17) (h), include 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 RWC 18.71.200 or RWC 18.73.030 (12), and whose duties include providing emergency medical services as defined by RCW 18.73.030.
- EMT’s are first responders. They benefit from the helpful PTSD rules.
Law Enforcement or Police Officers
- Law enforcement, as defined by RCW41.26.030 (19), includes 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.
- Law enforcement officers are first responders. They benefit from the helpful PTSD rules.
Public Safety Telecommunicator
- “Public safety telecommunicators” means individuals who receive and respond to telephone or other electronic requests for emergency assistance, such as law enforcement, fire, and medical services, and dispatch appropriate emergency responders. Public Safety Telecommunications RCW 51.08.142 (d)
- Public safety telecommunicators are first responders. They benefit from the helpful PTSD rules.
Direct Care Registered Nurse
- “Direct care registered nurse” means an individual licensed as a nurse who provides care to patients.
- The Direct Care Registered Nurse must have been employed on a fully compensated basis as a direct care registered nurse in Washington state for at least 90 consecutive days for this coverage to apply. See also 2SSB 5454
- They can file occupational disease claim for PTSD, but the presumptions do not apply.
What is post-traumatic stress disorder (PTSD)?
The American Psychiatric Association defines post-traumatic stress disorder as a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event, series of events, or set of circumstances. The individual may develop PTSD after an emotionally or physically harmful or life-threatening event(s) or extreme exposure to adverse details that may affect their mental, physical, social, and/or spiritual well-being. Symptoms of post-traumatic stress disorder fall into four major categories.
- Intrusion: Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks to the traumatic event.
- Avoidance: Avoiding reminders of the traumatic event by avoiding people, places, activities, objects, and situations that may trigger distressing memories.
- Alterations in cognition and mood: Inability to remember important aspects of the traumatic event, negative thoughts, and feelings leading to ongoing and distorted beliefs about oneself or others; distorted thoughts about the cause or consequence of the event; ongoing fear, horror, anger, guilt or shame; significantly decreased interest in previously enjoyed activities; feeling detached or estranged from others; or being unable to experience positive emotions.
- Alteration in arousal and reactivity: Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being overly watchful of one’s surroundings in a suspecting way; being easily startled; or having problems concentrating or sleeping.
What is the Statute of Limitations (SOL) for on the job PTSD?
There are three different Statutes of Limitations. The type of claim you have determines which SOL applies to your facts.
INJURY – The injury statute of limitations is one year from the date of the injury until you must file an L&I claim. See Statute of Limitations. Consult with an attorney.
OCCUPATIONAL DISEASE – The occupational disease statute of limitation is two years from the manifestation date of your occupational disease until you must file an L&I claim. You probably have longer than two years. See Statute of Limitations. Consult with an attorney.
THIRD PARTY CLAIM – The third party lawsuit Statute of limitations for an on the job claim is 3 years for negligence and 2 years for intentional injuries. See Statute of Limitations. Consult with an attorney.
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 and pay the price for what they do. The price they pay is on-the-job PTSD. 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 face life-and-death circumstances to restore law and order, their life thereafter is affected by the experience.
Over time these extremely 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. They deserve PTSD workers’ compensation benefits, and now, under the new law, they have better access to those benefits.
What do I do if I’m contemplating suicide?
Don’t Do It! Get the Help You Need Now! Post-traumatic stress disorder can be extremely difficult and lead to deep despair. However, several organizations and many people will assist you through the process. If you are contemplating suicide, please contact one of the following organizations to seek the help you need
- EMT & Firefighter Behavioral Health Alliance -provides helpful resources for first responders
- National Suicide Prevention Lifeline – Available 24 hours a day, simply dial 988
- Suicide Prevention King County – Helpful online information
- L&I and Suicide – What to do with a job-related suicide
Old and Current L&I INJURY Law (Applicable to Everyone)
The Law for all claims (first responders and everyone else too), as per RCW 51.08.100 and WAC 296-14-300, is that post-traumatic stress disorder caused by one stressful event can be allowed as a workers’ compensation injury. A one-time 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 and then develops PTSD will have a permissible workers’ compensation 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.
- More detail at WAC 296-14-300 (2)
Old and Current L&I OCCUPATIONAL DISEASE Laws (Applicable to Everyone Except First Responders)
The law for every worker who is not a first responder is that traumatized workers cannot file a PTSD claim for cumulative trauma. There is an L&I rule that claims mental conditions or mental disabilities caused by stress do not fall within the definition of Occupational Disease, as per RCW 51.08.142 (1).
If you find this confusing, don’t worry, it goes with the territory. L&I occupational disease law is confusing. However, these cases can be won. Call us for help if you need it.
Do I need a lawyer to help receive workers’ compensation benefits resulting from PTSD?
While working with an experienced L&I lawyer may help, many workers’ compensation claims for PTSD can be handled without legal representation. It helps to understand and pay attention to what is written here. Your medical records will define and limit your ability to collect workers’ compensation benefits. Be honest, precise, and careful when communicating with doctors or triage nurses when they have a pen in their hand.
If you’re suffering from PTSD and wish to discuss your case, contact the Sharpe Law Firm to schedule a consultation. By the end of our call, you’ll have an action plan and a better understanding of how to proceed with your case. You do not have to be our client to get a free consultation.