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Workers’ Compensation PTSD Presumption, Benefits Change

January 02, 2019

The Minnesota Legislature passed a bill in 2018 to amend the workers’ compensation statute to provide an evidentiary presumption for post-traumatic stress disorder (PTSD) in first responders. The law took effect Jan. 1, 2019.

The presumption is that a diagnosis of PTSD made following an incident that occurred while the employee is on active duty in one of the covered positions with no prior diagnosis of PTSD is presumed to be an occupational disease.

The new law applies to the following positions: licensed police officers, firefighters, paramedics, emergency medical technicians, licensed nurses employed to provide emergency medical services outside of a medical facility, public safety dispatchers, officers employed by the state or a political subdivision at a corrections or detention facility, sheriffs and full-time deputy sheriffs of any county, and members of the Minnesota State Patrol.

The presumption can be rebutted. If at the time a denial of liability is communicated to the employee there are substantial factors that impact the presumption, they must be included in the denial.

When handling claims of PTSD, MCIT must consider the factors or requirements that remain unchanged in workers’ compensation. First, the employer/insurer is required to make a decision whether to accept or deny a claim within 14 days of receiving the claim of PTSD. Ideally, when the claim is presented, it should include the required evidence to support it. Often, the evidence is not submitted, which results in a denial.

To be compensable, the statute requires a diagnosis of PTSD as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders made by a licensed psychologist or psychiatrist. The requirement for the psychological/psychiatric report mirrors similar requirements for compensable physical injuries.

Second, the employee must show the injury arose out of and in the course of employment. Even with the presumption, the records need to be reviewed to ensure that PTSD arose out of the current job and not previous work experience or personal conditions. Any prior mental health records that can be provided at the time PTSD is claimed will expedite the decision of compensability.

Help Facilitate Claim Processing

When it is an employee’s job to file the First Report of Injury on behalf of the employer with MCIT, that individual should inform the injured/ill employee that he or she must include a report from a licensed psychologist or psychiatrist that shows a diagnosis of PTSD as defined by the current Diagnostic and Statistical Manual of Mental Disorders, either at the time of submitting the FROI or as soon as possible.

If the injured/ill employee does not have the documentation to include with the First Report of Injury, the employee responsible for filing claims on behalf of the employer should still submit the claim. He or she should never prevent an injured/ill employee’s claim from being filed.

Other Workers’ Compensation Legislative Changes

Although efforts to pass the presumption for PTSD for first responders took center stage last session, there were a number of less obvious but equally important bills passed that will affect the cost and administration of future workers’ compensation claims.

Permanent Total Disability (PTD): Prior to Oct. 1, 2018, there was a rebuttable presumption that permanent total disability benefits end when the injured worker reaches age 67. This is changed for all dates of injury that occur on or after Oct. 1, 2018. The new rebuttable presumption to end PTD disability benefits is age 72; however, if the claimant is injured after the age of 67, PTD benefits will end five years after injury.

For example, an employee who was declared permanently and totally disabled at age 66 on Oct. 1, 2018, is now presumed to have six years of PTD benefits available instead of one. To demonstrate the financial impact of the change assume the following:

A 66 year-old employee with an injury date of Jan. 1, 2018, and a PTD rate of $500 per week, would be entitled to $25,000 in PTD benefits.

The same employee now injured on Oct. 1, 2018, would be entitled to $150,000 in PTD benefits because the retirement presumption is 72 years old. The employee gains an additional five years of benefits.

This change in retirement presumption will likely have an effect on the settlement value of all indemnity claims occurring on or after Oct. 1, 2018.

Temporary Partial Disability (TPD): Prior to Oct. 1, 2018, there was a statutory cap of 225 weeks of TPD exposure related to any single date of injury, and these 225 weeks of TPD must have been accrued within 450 weeks of the date of injury. For all dates of injury that occur on or after Oct. 1, 2018, a new statutory cap of 275 weeks of TPD exposure related to any single date of injury takes effect. As an example, an employee earning $500 per week in TPD benefits now is entitled to an additional $25,000 over the life of the claim.

Permanent Partial Disability (PPD): Effective Oct. 1, 2018, the dollar values in the compensation schedule as set in statute for PPD benefits increased by 5 percent.

With these changes it is more important than ever to assist injured employees with their recovery efforts, including returning them to work in some capacity as soon as possible.

Contact MCIT with Questions

Members with questions about workers’ compensation should contact MCIT Workers’ Compensation Claims Manager Andrew Essling at 1.866.547.6516, ext. 6423 or aessling@mcit.org.