Mental Health Conditions Caused by Stress Excluded from the Definition of Occupational Disease.
Workers who are injured or suffer a disability from an occupational disease in the course of employment are entitled to certain benefits under the workers' compensation program administered by the Department of Labor and Industries (L&I). An occupational disease is a disease that arises naturally and proximately out of employment.
Mental conditions or mental disabilities caused by stress are excluded from the definition of occupational disease. Examples of excluded conditions caused by stress are conditions and disabilities resulting from: (a) changes in employment duties; (b) conflicts with a supervisor or relationships with coworkers or the public; (c) work load pressures; (d) subjective perceptions of employment conditions or environment; and (e) fear of exposure to chemicals, radiation biohazards, or other perceived hazards.
Stress resulting from exposure to a single traumatic event may be allowed as an industrial injury. Examples include actual or threatened death, actual or threatened physical assault, actual or threatened sexual assault, and life-threatening traumatic injury. The worker must have been exposed to the event by: (1) directly experiencing the traumatic event; (2) witnessing, in person, the event as it occurred to others; or (3) extreme exposure to averse details of the traumatic event. Repeated exposure to traumatic events, none of which is a single traumatic event, is not an industrial injury or an occupational disease.
Workers' Compensation Coverage for Post-Traumatic Stress Disorder as an Occupational Disease.
The exclusion of stress-related mental health conditions from the definition of occupational disease does not apply to occupational disease claims resulting from post-traumatic stress disorders of certain firefighters, law enforcement officers, public safety telecommunicators, and direct care registered nurses under specified circumstances. There is a rebuttable presumption that post-traumatic stress disorder (PTSD) is an occupational disease for certain firefighters, law enforcement officers, and direct care registered nurses. The presumption is extended following termination of service or employment for a period of three calendar months for each year of requisite service or employment but not beyond 60 months following the last date of employment. The presumption only applies to active or former firefighters and law enforcement officers who have PTSD that develops or manifests after at least ten years of service and for direct care registered nurses after the nurse has been employed on a fully compensated basis as a direct care registered nurse in Washington for at least 90 days.
Post-traumatic stress disorder is not considered an occupational disease if the disorder is directly attributed to disciplinary action, work evaluation, job transfer, layoff, demotion, termination, or similar action taken in good faith by an employer. Post-traumatic stress disorder means a disorder that meets the diagnostic criteria for post-traumatic stress specified by the American Psychiatric Association in the Diagnostic and Statistics Manual of Mental Disorders, Fifth Edition, or in a later edition as adopted by L&I in rule.
Safety and Health Investment Projects.
The director of L&I may provide funding through the Medical Aid Account for safety and health investment projects in workplaces insured through the state fund. Funds must be distributed as follows:
Use of Safety and Health Investment Project Return-to-Work Funds.
The Department of Labor and Industries may use safety and health investment project funds allocated for projects related to return-to-work programs to provide grants or contracts for the development and evaluation of workplace behavioral health programs focused on occupations that have a high risk of PTSD through repetitive exposure to trauma. The Department of Labor and Industries may determine appropriate organizations eligible for awards.
Pilot Program for Post-Traumatic Stress Disorder Occupational Disease Claims.
In consultation with experts from L&I and advisory committees, including the Workers' Compensation Advisory Committee, L&I must design and implement a pilot program to expand access to care for workers exposed to trauma seeking workers' compensation coverage for PTSD as an occupational disease. Self-insured employers may choose to participate in the pilot program.
Worker Participation in the Pilot.
When an eligible worker files a claim for PTSD as an occupational disease, L&I or the participating self-insurer must provide the worker with the opportunity to participate in the pilot program. If the worker opts for the worker's claim to be part of the pilot, L&I or the participating self-insurer must authorize treatment for PTSD prior to claim adjudication without regard to whether the worker's claim for benefits is ultimately allowed.
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 L&I's medical aid rules and fee schedules and signs a nonnetwork provider agreement. Once a claim is allowed, the worker must seek treatment within the medical provider network. The Department of Labor and Industries 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.
Treatment Under the Pilot.
Treatment for PTSD prior to claim adjudication must be limited to a diagnostic interview and up to 11 treatment sessions for PTSD to occur within 90 days of filing the claim. If a claim has not been adjudicated within 90 days, the supervisor of industrial insurance may authorize continued treatment of up to 12 sessions. The Department of Labor and Industries 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.
Costs of Treatment Under the Pilot.
Costs for treatment prior to adjudication on state fund claims that are ultimately rejected must 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 must be paid by the participating self-insured employer.
Provider Agreements Under the Pilot.
To improve access to trauma-informed care, L&I may enter into agreements with health care organizations or providers experienced in the diagnosis, assessment, and treatment of PTSD. Organizations and providers must meet qualifications and requirements established by L&I. The Department of Labor and Industries may identify and implement financial and other incentives for participating providers, develop criteria for workers to receive services under the agreements, and develop criteria for evaluating the success of these agreements. The agreements may not be used to limit workers' choice of provider or organization for mental health treatment.
Addressing Administrative Requirements Under the Pilot.
To address barriers for workers and treating providers participating in the pilot program, L&I may reduce administrative requirements such as documentation, timelines, reporting, or prior authorization imposed solely for treatment under the pilot program.
Reporting and Recommendations.
Self-insured employers who participate in the pilot must produce upon request a report to L&I of all workers' compensation claims subject to the pilot.
By July 1, 2030, L&I must provide recommendations to the appropriate committees of the Legislature on:
The pilot program expires on December 31, 2030.
The Department of Labor and Industries is granted rulemaking authority to implement the program.
| House | 90 | 1 | |
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| Senate | 49 | 0 |
| Effective: | July 1, 2026 June 30, 2027 (Section 3) |
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