The new year brought with it an expansion of Connecticut’s workers compensation benefits with regard to post-traumatic stress injuries or disorders (PTSD).

Prior to January 1, only first responders were eligible for benefits for work-related PTSD; now under a new law (SB913) all employees subject to the workers compensation law are eligible if the qualifying injury is work-related.

The new law makes all employees eligible for workers compensation benefits if a mental health professional diagnoses PTSD as a direct result of an event that occurs in their course of employment in which they:

• View a deceased minor.
• Witness someone’s death or an incident involving someone’s death.
• Witness an injury to someone who then dies before or upon admission to a hospital as a result of the injury and not any other intervening cause.
• Witness a traumatic physical injury that results in the loss of a vital body part or a vital body function that permanently disfigures the victim.
• Carry, or have physical contact with and treat, an injured person who then dies before or upon admission to a hospital as a result of the injury and not any other intervening cause.

As with eligibility for first responders, the qualifying event must be a substantial factor in causing the injury and injury must not have resulted from a disciplinary action, work evaluation, job transfer, layoff, demotion, promotion, termination, retirement, or similar action.

Under the new law, the benefits themselves remain subject to the same procedures and limitations that apply to the PTSD benefits for first responders. Benefits are capped at 52 weeks and cannot be awarded more than four years after the qualifying event. Employers contesting a claim for PTSD benefits must do so through a process that is similar to the one used for contesting other workers compensation claims.

Lobbying For and Against

Labor and nurses were among the interests supporting the change, while lobbyists for businesses including insurance and for municipalities opposed it during legislative hearings on the measure in early 2013. Opponents warned about the costs of expanding the benefit while supporters spoke about how the coverage would help injured workers.

Labor unions came out in support. Brian Anderson, legislative director for Council 4 AFSCME, which represents police officers and police department employees, recalled recent instances where PTSD coverage might have been helpful. These included a school nurse in Sandy Hook who watched as the shooter walked by her office and Bristol police IT techs, who as part of their job, had to watch the murder of two of their friends on body camera video. Also, grocery store and warehouse workers who have had to witness mass shootings.

“All these circumstances could cause PTSD,” Anderson told lawmakers at the hearings on the bill. “It is time to extend this coverage to all workers.”

Anderson maintained that the law will “no doubt remain strict” because a licensed psychologist or psychiatrist must diagnose.

Nurses’ Stress

Kimberly Sandor, RN, FNP, executive director of the Connecticut Nurses Association, added her profession’s support. She testified that nurses work in a challenging environment with high levels of stress due to the nature of the work, compounded by physical and verbal violence and staffing shortages. They participate in decisions and actions to save lives throughout the day, she noted.

“PTSD is a diagnosable mental health disorder that is common among nurses and requires specific treatment,” Sandor said, citing a statistic that nearly 30% of nurses suffer from PTSD during their careers. This, she said, contributes to high rates of turnover in the profession and causes long-lasting impacts on health and happiness.

“While nurses are resilient and use humor and social supports to cope with experiences, for some it can lead to trauma that needs to be treated. Expanding this coverage demonstrates an understanding and normalizing of the experiences on the job and provides a pathway for treatment,” she added.

Declining Rates

Insurers, businesses and municipalities expressed concern over the costs of expanding the benefit to all employees.

Over the past nine years, workers compensation rates have steadily decreased in the state, as have the number of workplace injuries and claims filed. Insurers said that expansion of coverage will not only cause an increase in risk and premiums for policyholders, but also prove more costly for local governments and self-insured entities.

Peter Myers, from the Connecticut Business & Industry Association, cited the years of declining workers compensation claims and rates as a “positive step for Connecticut workers and businesses” that businesses hope will continue. He cautioned against a broad expansion of PTSD benefits that “could be taken advantage of” and result in higher costs for employers “because of the complexity of identifying and the limited tests available to identify post-traumatic stress injuries.”

Physical Injury

Connecticut workers compensation law has historically excluded mental stress claims from the definition of personal injury “unless such impairment arises from a physical injury or occupational disease.” The insurance industry and others said they opposed the new law in part because by expanding benefits beyond first responders it would further erode this requirement that has helped keep workers compensation costs in check.

Related article: Should Carriers Worry About Workers Comp? Yes and No

The American Property Casualty Insurance Association (APCIA) maintained that mental stress claims such as PTSD are by their nature “extremely subjective and personal” and also potentially prone to abuse. “The physical injury requirement provides critical evidentiary proof of the validity of the claim and prevents possible overburdening of the workers compensation system with such claims,” the trade group said.

“Expanding coverage for PTSD injuries to all employees, not just first responders, would cause workers compensation insurance premiums to become prohibitively expensive for Connecticut employers, and have a significant impact on the workers compensation system,” said Brooke Foley, general counsel for the Insurance Association of Connecticut (IAC), representing the state’s insurers.

The IAC acknowledged that reliable statistics on mental emotional injury claims are not readily available. But it cited reporting from the League of Minnesota Cities Insurance Trust, a self-insured membership cooperative, that PTSD claims make up about 31 percent of its annual workers compensation claim costs, most from police claims. The majority of PTSD costs were said to be for covering lost wages for employees who do not return to work after their diagnosis.

Small Towns and Businesses

“We are concerned that this legislation will result in significant costs to employers, particularly small businesses, during a time of economic instability and inflation,” testified Scott Hobson, on behalf of the Big I Connecticut insurance agents organization. Hobson noted that New York Gov. Kathy Hochul recently vetoed similar legislation over economic concerns.

Betsy Gara, executive director Connecticut Council of Small Towns, noted that lawmakers had already expanded the class of municipal employees eligible for PTSD benefits from police officers, parole officers, and firefighters to add emergency medical services, all Department of Correction employees, 911 emergency dispatchers, and some health care providers despite the heavy burden this places on towns and local property taxpayers.

“Unfortunately, the cost of this unfunded mandate will be borne by already overburdened property taxpayers throughout the state. Towns are increasingly concerned about how inflation will impact local budgets and property taxes,” Gara told lawmakers. “Lawmakers should reject efforts to impose new or expanded unfunded mandates on municipalities which put considerable pressure on local property taxpayers.”

Other Legislation

In October, a new law went into effect making it easier for firefighters who develop cancer to receive workers compensation benefits. This law creates a presumption during the review process of workers compensation claims that a firefighter’s cancer diagnosis is job-related unless proven otherwise. It applies to any uniformed member of a paid municipal, state, or volunteer fire department, as well as local fire marshals, deputy fire marshals, fire investigators, fire inspectors, and other classes of inspectors and investigators.

This article was originally published by Insurance Journal.