Recent Legislative Changes Impacting Mental Health Coverage for First Responders Injured at Work
by K. Kline
When we think about workers’ compensation, we often think of cases involving bodily injury claims – traumatic physical injuries, occupational exposure, and similar examples immediately come to mind. Psychiatric injuries, while they have long been a part of the workers’ compensation landscape, historically have not been among the top claim generators. Moreover, they can be difficult for injured workers to prove. While jurisdictions differ, it is not uncommon for states to require an injured worker to prove a specific incident, demonstrate extraordinary or unusual workplace stress, or sustain a corresponding physical injury for a claim to be considered compensable.
Recent Legislation Introduced
However, recently several states have either extended, or are considering extending, protections to a larger array of mental health injuries, particularly in cases involving first responders. In Kentucky, for example, a recently introduced bill (25 RS BR 1228) would expand the definition of injury to include certain psychological claims even without a corresponding physical injury. The proposed bill would also create a rebuttable presumption that post-traumatic stress disorder (PTSD) is a compensable injury if diagnosed by a qualified mental health practitioner within three years of the last day of active employment as a first responder. Instead of requiring a worker to prove their injury was occupationally related, it would become the employer’s burden to show that the claimant’s PTSD was caused by factors unrelated to employment.
Pennsylvania is another state that has recently taken steps towards expanding coverage. Specifically, Senate Bill 365, signed into law in late 2024, lowers the burden of proof necessary for a first responder to establish a claim for mental health injury. Previously, claimants were required to show that an abnormal work environment, specific to their occupation, caused the injury. Because of the nature of the work, this created obstacles in claiming psychological injury, even though first responders are often witness to extreme tragedy. To ensure mental health services are more accessible to first responders, Pennsylvania removed this requirement, and effective October 29, 2025, conditions such as PTSD may be considered compensable even without demonstrating abnormal work conditions.
Kentucky and Pennsylvania are not alone. Multiple states including New York, North Carolina, and Texas, have taken steps to acknowledge the unique mental health challenges faced by first responders. Studies have shown that the prevalence of trauma-related psychological conditions among first responders is substantially higher than the general population[1]. By itself, this is significant, but demographic data also shows that first responders tend to be younger than the average US worker. The median US labor force age was 41.6 in 2023[2]. The median age for emergency medical technicians, in contrast, is 36[3].
Potential Impact on Claim Costs
Providing injured workers with access to care is, of course, the purpose of workers’ compensation. It is possible, however, that expanding access to mental health claims for younger workers in high stress fields could result in an overall increase in claim costs. This is especially true in cases with active, ongoing treatment at the time of settlement. For example, if a claimant is receiving twice-monthly psychotherapy at the time of settlement, CMS will include this treatment in the MSA over the claimant’s lifetime. Assuming a 25-year life expectancy in Pennsylvania, the cost for psychotherapy alone would be $86K. It is possible that earlier access to mental health treatment could result in an earlier return to work and help offset some costs, but the potential for increased claim costs associated with expanded access exists.
While the ultimate outcome of these legislative changes is unknown, it is likely carriers will see an increasing number of successful claims as states move towards strengthening protections for first responders. If you have any questions about the potential impact of these changes or how IMPAXX can assist in managing claim costs associated with psychological treatment, please contact our Settlement Consulting team at [email protected].
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC6624844/
[2] https://www.bls.gov/emp/tables/median-age-labor-force.htm
[3] https://www.zippia.com/paramedic-jobs/demographics/