Under Washington's industrial insurance program (workers' compensation), a worker who is injured or suffers a disability from an occupational disease in the course of employment is entitled to certain benefits.  Employers in Washington must obtain coverage either through the Industrial Insurance Fund administered by the Department of Labor and Industries (Department) or by qualifying to self-insure.  Self-insured employers cover costs associated with an on-the-job injury or occupational disease and administer claims.

Depending on a worker's occupation, treatment for post-traumatic stress disorder (PTSD) may be covered by workers' compensation as an injury from exposure to a single traumatic event, or as an occupational disease, from repeated exposure over time.  For all workers, PTSD may be covered as an occupational injury when a worker is exposed to a single traumatic event that causes them to develop PTSD.  For public safety telecommunicators, like 911 operators, a PTSD claim may be covered as an occupational injury or an occupational disease.  For firefighters, fire investigators, emergency medical technicians, law enforcement officers, and direct care registered nurses, PTSD may be covered as either an occupational injury or an occupational disease, and there is a presumption that PTSD is caused by the work.

To receive workers' compensation coverage for treatment, a workers' compensation claim must be filed with and adjudicated by the Department.  A workers' compensation claim is closed when a worker reaches maximum medical improvement, meaning the worker's condition is fixed and stable.  In most cases, a closed claim may be reopened if the condition worsens and the worker submits an application within seven years of claim closure.

The Department of Labor and Industries (Department) is authorized to use funds allocated for return-to-work programs to provide funding for workplace behavioral health programs focused on occupations that have a high risk of post-traumatic stress disorder (PTSD).  The Department may determine appropriate organizations eligible for awards.

A pilot program is established to increase access to care for workers seeking workers' compensation coverage for PTSD as an occupational disease.  The Department must provide eligible workers with the opportunity to participate in the pilot program, and the workers may opt in.  The Department and participating self-insured employers must authorize treatment for PTSD prior to claim adjudication for a worker who opts in to the pilot program, regardless of whether the claim for benefits is ultimately allowed.  A diagnostic interview and up to 11 treatment sessions within 90 days of diagnosis may be authorized prior to claim adjudication.  A worker may receive treatment prior to claim adjudication from a provider outside the medical provider network if the provider agrees to be paid in accordance with the Department's medical aid rules and fee schedules and signs a nonnetwork provider agreement.  The Department must contact nonnetwork providers who agree to provide treatment as part of the pilot program to better understand barriers to entering the medical provider network.  Once a claim is allowed, the worker must seek treatment within the medical provider network.  Costs for treatment prior to adjudication on state fund claims that are ultimately rejected will be spread across all risk classes for which there is a presumption of coverage for PTSD as an occupational disease.  Costs for treatment on self-insured claims that are ultimately rejected will be paid by the self-insured employer.

The Department and participating self-insured employers must authorize up to six additional PTSD treatment sessions within one year of claim closure when necessary to maintain a worker's level of functioning at the time of claim closure.  The supervisor of industrial insurance may authorize continued treatment of up to 12 sessions, if a claim has not been allowed within 90 days.

The Department may enter into agreements with healthcare organizations and providers for workers to receive services and may modify administrative requirements such as documentation, timelines, reporting, or prior authorization for workers and treating providers participating in the pilot program.

Self-insured employers must produce upon request a report of all workers' compensation claims subject to the pilot.

If the pilot program provisions conflict with an existing statute, the pilot program supersedes the conflicting statute for the duration of the pilot.  The Department has rulemaking authority to implement the program.

By July 1, 2030, the Department must provide recommendations to the Legislature based on the pilot.

(In support) This pilot will allow workers with workers' compensation claims for PTSD to start treatment more quickly.  Over the last decade, the Legislature has extended workers' compensation coverage for PTSD as an occupational disease to firefighters, law enforcement officers, nurses, and 911 operators.  These claims more often result in pensions, with workers unable to return to work.  This bill creates a pilot for those four occupations to get them treatment earlier and reduces barriers.  The pilot will allow workers to have treatment right away during the claim allowance process and will make treatment available after the claim is closed.  It will expand the use of Safety and Health Investment Program grants to do more research without requiring additional funds.  Timely treatment is essential.  We can do more to help people who are struggling, and this is an opportunity to do that.

(Opposed) None.

(Other) There is concern about treatment before claim allowance disrupting current treatment patterns for providers and workers.  Research should focus on prevention within the workplace environment and reintegration into the workforce.  Additionally, this should not become an effort to deliver more psychiatric drug treatment. 

(In support) None.

(Opposed) None.

(In support) Representative Suzanne Schmidt, prime sponsor; Patrick Connor, NFIB; and Tammy Fellin, Department of Labor and Industries.