Some Workers in Pennsylvania are Now Eligible to Claim Workers’ Comp Benefits for PTSD Without Having to Prove Abnormal Work Circumstances

According to recent studies, one out of every seven first responders suffers from a post traumatic stress injury. That’s over 14% of firefighters, police, EMTs, and others who serve and protect the public. Changes in Pennsylvania law recently took effect that are designed to make it easier for these workers to obtain workers’ compensation benefits.

Traditionally, first responders have had a difficult time qualifying for benefits because of standards that were in place specifying that injuries of this type had to result from “abnormal working conditions” to be covered. The unfortunate reality for first police, firefighters, and emergency workers is that their everyday working conditions are often horrific and traumatic. Under the new laws, first responders should now be eligible for benefits, but they will need to prove that they meet eligibility requirements.

Who is Covered by the New Law?

The new provisions added to the workers’ compensation laws apply to workers who meet the definition of “first responders,” which includes the following public servants:

• Emergency medical services (EMS) providers (if they are a municipality’s primary EMS provider or dispatched by a public safety answering point)
• Volunteers, employees, and members of fire companies that respond to emergency calls
• Pennsylvania State Police officers
• Peace officers who respond to emergency calls

It should be noted that the definition includes both employees and volunteers.

Other workers who suffer from PTSD symptoms are still required to follow the previous standards. They must show that “abnormal working conditions” led to their PTSI.

What Qualifies as a Post-Traumatic Stress Injury?

The new law retains the current definition of a “post-traumatic stress injury,” which is found in 35 Pa. C.S. 75A01. That definition states that a post-traumatic stress injury is the same as a post-traumatic stress disorder, as defined by the American Psychiatric Association. This definition is documented in the Association’s Diagnostic and Statistical Manual of Mental Disorders. In brief terms, it consists of a mental health condition caused by exposure to a serious, threatening, or traumatic event that causes intrusive symptoms, triggers avoidance, causes negative cognitions or memory loss, and leads to reactivity issues such as reckless behavior or sleep difficulties. 

What is the difference between a post-traumatic stress injury and post-traumatic stress disorder? Both essentially refer to the same set of symptoms, such as flashbacks and anxiety, but with a different focus. PTSD is seen as a mental health disorder, while PTSI is viewed as a physical injury that has been inflicted on the body’s nervous system. PTSI focuses on the biological changes in the brain as a result of the trauma, and treatment may emphasize physical interventions as well as mental health therapy.

Since Pennsylvania lawmakers refer to PTSI but link the definition to PTSD, and the symptoms are essentially identical, it could be safe to assume that the changes in workers’ compensation law apply to a diagnosis of either PTSD or PTSI.

The Key Changes in the New Law

According to the new law, when a first responder files a claim for workers’ compensation benefits based on a post-traumatic stress injury, the claimant will need to prove that the injury/symptoms resulted from their experience of a “qualifying traumatic event.” This is defined as an episode that resulted in either:

• Serious bodily injury or death to an individual
• Injury, killing, abuse, or exploitation of a minor
• An immediate threat to the claimant’s life or someone else’s life
• Mass casualties
• Being called in to witness and respond to the scene of a crime

Experience of the traumatic event must come during the “course and scope of the individual’s employment as a first responder.” This is true of any injury that qualifies for workers’ compensation benefits. One feature that is different now, however, is that the law says “[a] post-traumatic stress injury suffered by a first responder shall not be required to be the result of an abnormal working condition to be a compensable injury under this act.” Before this new law was enacted, first responders were almost systematically excluded from receiving benefits for PTSD because the trauma was usually the result of working conditions that were part of their normal job.

Limitations on PTSD Benefits

While it might seem clear that the public servants who respond to emergency situations and put their own safety on the line for the benefit of others should be granted assistance for PTSD with no questions asked, that is not the case. First responders still need to prove their condition with evidence of an assessment and diagnosis by a licensed psychologist or psychiatrist. The requirement of a specific diagnosis is often used by workers’ compensation insurance providers as grounds to deny claims, so it can be very helpful to work with a knowledgeable attorney when filing a claim based on PTSD.

Claims must be filed within three years of the diagnosis of a PTSI. However, the qualifying traumatic event that triggered PTSD symptoms could have occurred up to five years previously. Wage loss benefits for workers suffering from a PTSI cannot continue for more than two years. There may not be a limit on how long a first responder can continue to receive treatment for the symptoms, however.

Find Out How a Workers’ Compensation Lawyer Can Help

Workers’ compensation is supposed to help workers who are injured on the job. Unfortunately, the insurance companies that pay for medical benefits and wage benefits challenge the details of every claim and find arguments to deny benefits, no matter how much a worker is suffering.

If you need to file a claim for a PTSI or any other injury caused by your experience at work, the experienced team at Vanasse Law may be able to assist. We invite you to contact us to discuss your claim, whether you have not yet started the claims process or you’ve received notice that your claim was denied. We understand how to successfully appeal denials to get workers the benefits they deserve. To schedule a free consultation, call us at 717-397-1010 or contact us online today.