California workers’ compensation law has been amended in recent years to make it easier for firefighters to get treatment for post-traumatic stress disorder (PTSD) covered. There’s no question that with California’s “fire season” now essentially all year long, the mental health of many of those tasked with fighting more frequent and destructive fires have suffered.
Under current law, there’s a “disputable” or rebuttable presumption that if a firefighter is diagnosed with PTSD, it “arises out of and comes in the course of employment.” That presumption means the burden of proof is on insurers or employers to show that a firefighter’s condition wasn’t caused by their job.
Unfortunately, the change in the law hasn’t created the kinds of changes in real life that are necessary for current and former firefighters to get the mental health treatment they need – even when their condition leads to suicide attempts, hospitalization or the inability to go about their lives.
Why are so many claims denied?
As many as a quarter of firefighters’ workers’ comp claims for PTSD are denied. Many more take so long to process that many therapists have had to decline to treat firefighters if they can’t pay for the treatment themselves or through their own health insurance. Those who do treat firefighters often have to provide extensive documentation of their patients’ condition.
Part of the problem is that PTSD is often the result of cumulative trauma. A firefighter may not have any one specific event that led to their PTSD. That can be enough for an insurer to argue that there’s no proof that the PTSD is work-related. As one claims adjuster said, “with cumulative trauma…we need to request more information from the doctor so that we can see it isn’t because they were in the military or they are going through a divorce, etc.”
If a therapist won’t treat a patient because they don’t know if or when they’ll be paid, a vicious cycle can begin. It’s even harder to find a therapist who will take the risk to treat firefighters in rural areas where many retired firefighters with PTSD and other mental health disorders relocate for a quieter, less stressful life.
Firefighters are increasingly getting legal guidance to help them navigate California’s overburdened and complex workers’ comp system. Seeking legal guidance may be the best chance for a firefighter to get the mental health care and compensation they desperately need.
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