Labor and Industries (L&I) presented a work session to the Senate Labor & Commerce Committee on post‑traumatic stress disorder (PTSD) claims in Washington’s workers’ compensation system, detailing claim volumes, cost patterns and ongoing prevention and clinical‑guideline work.

Brenda Heilman, assistant director for the workers’ compensation program at L&I, and Dr. Dave Bonnato, research director for the SHARP prevention program, told the committee that PTSD claims—particularly those filed by firefighters and law‑enforcement officers under statutory presumptions—have driven a substantial share of claim costs in the affected risk classes.

Key findings presented:
- Presumptive coverage: Washington law creates an occupational disease presumption for firefighters, law‑enforcement officers and certain emergency responders in specific circumstances; direct‑care registered nurses were added to presumption coverage in 2023 with a 90‑day work requirement.
- Claim volume and disposition: Since the presumption’s 2018 start, PTSD claims rose and peaked around 2021; through September of the presentation year L&I reported 435 PTSD claims at the State Fund and 280 at self‑insured employers across covered job classes. State Fund and self‑insured PTSD claims were allowed at roughly an 80% rate with about 20% denied or pending.
- Costs and outcomes: L&I’s analysis showed average costs for compensable PTSD claims and pensions were substantially higher than average State Fund claims. L&I reported that about one in five PTSD claims for firefighters and law enforcement result in pension—much higher than typical claim pension rates—raising concerns about long‑term disability and system sustainability. The department presented examples: a medical‑only PTSD claim averaged about $24,000, while compensable PTSD claims and pensions averaged substantially higher (figures updated internally by L&I's actuarial team).
- Rate impacts: PTSD claim costs increased the premium rates for certain risk classes; L&I noted that firefighters’ and law‑enforcement officers’ premium rates rose substantially in recent years (examples cited: historic increases of roughly 65% for firefighters and 80% for law enforcement in the period covered), and staff said the committee capped some risk‑class increases at 15% to limit immediate premium shock and socialize costs where appropriate.

Prevention and next steps: Dr. Bonnato described prevention tiers—primary (reduce exposure), secondary (rapid identification and treatment) and tertiary (rehabilitation and return‑to‑work)—and noted evidence on some previously used approaches (for example, critical incident stress debriefing) is mixed or may be harmful if misapplied. L&I described workstreams begun under recent legislation (including HB 2311) to develop peer‑support programs, clinical guidelines (via the Industrial Insurance Medical Advisory Committee), and pilot efforts to improve outcomes and reduce long‑term disability. L&I staff said they will continue to study other jurisdictions’ approaches and flagged the need for better access to mental‑health providers and clearer clinical guidance.

Questions from committee members focused on how rate changes are socialized across the State Fund, the connection between pension costs and overall system sustainability, the prevalence of claims among newly covered occupations (registered nurses), and how employers and peer‑support systems can intervene earlier to prevent long‑term disability. Chair Saldanha and several senators asked L&I to provide more detailed actuarial and rate‑setting information in a follow‑up briefing.

Ending: L&I concluded that PTSD claims have concentrated costs in particular occupational risk classes and that the agency will pursue prevention, clinical guidance and data review to improve outcomes and inform future policy decisions. Committee members signaled interest in a follow‑up presentation with additional actuarial and investment‑return context.