Court’s decision on firefighter’s PTSD sheds light on traumatic incident doctrines

Experts say a Pennsylvania appeals court decision that granted workers compensation benefits to a firefighter with post-traumatic stress disorder brought to the forefront the issue of what passes muster as an incident that can cause a mental injury.

The Commonwealth Court of Pennsylvania on Oct. 22 granted workers compensation benefits to the firefighter, who was diagnosed with PTSD after performing cardiopulmonary resuscitation on two infants within 16 months, as documented in No. 770 C.D. 2024. Both infants died.

The state’s Workers’ Compensation Appeals Board ruled that the Upper Darby Township firefighter’s mental condition was not compensable; both the board and a workers comp judge said providing CPR is not an abnormal working condition, a previous requirement first responders needed to show. The Commonwealth Court, however, said that under an “abnormal working condition analysis” in state law, the firefighter established that it was considered “rare” to witness the deaths of two infant children within 16 months.

A footnote in the decision was that the state has changed its law on PTSD for first responders to include the language “qualifying traumatic event,” which would presume compensability for a first responder suffering from PTSD after witnessing an incident such as death. The firefighter’s claim fell outside of the bill’s effective date of Oct. 29, 2025.

Several other states, such as Florida and Connecticut, changed laws in recent years to stipulate that a “qualifying” event must cause a first responder’s PTSD; such laws typically include a list of incidents. In 2024, Connecticut expanded its law to include all workers.

States with qualifying incidents in their laws still face the dilemma related to job description because police officers and firefighters witness death regularly, said Brian Allen, Salt Lake City-based vice president of government affairs for Enlyte.

Because of the expansion of PTSD presumptions for first responders, now in the books in nearly three dozen states, claims “are getting litigated more often,” Mr. Allen said. “That’s kind of inherent in the job, seeing people who were seriously injured or in dire medical conditions, and you’re going to lose some people,” he said.

Many state presumptions are “rebuttable,” meaning that if the employer can establish another cause for the mental injury, the presumption can be nixed. The presumption also may be rebutted if the first responder can’t point to an incident that occurred within the timeframe of the newly enacted laws.

In response to gray areas brought on by state laws with stricter provisions, Mr. Allen pointed to a growing trend of states — Utah, Arizona and Texas, as examples — providing better mental health resources for first responders vs. relying on the workers compensation system. He added that municipalities are already seeing workers comp costs increase as a result of PTSD presumptions for first responders.

The “research is clear” that first responders suffer from mental injuries and often commit suicide at greater rates than the general population, said John Violanti, Buffalo, New York-based research professor of epidemiology and environmental health with the University at Buffalo School of Public Health and Health Professions.

While claims continue to be litigated, he said, there’s an “evolution” in mental wellness for first responders to keep the issues out of the courts. “The idea is to catch it before it’s too late,” Mr. Violanti said.

While the new law in Pennsylvania makes it clear that the firefighter’s claim would be compensable had the incidents occurred after the law took effect, a concurring opinion in the Oct. 22 decision could help crack the door wider for all workers with mental injuries, said Barak Kassutto, a workers comp attorney with Krasno, Krasno & Onwudinjo in Philadelphia.

Pennsylvania case law requires that for a mental injury to be compensable for any worker, the worker needs to have experienced a “rare” working condition or event. As the concurring judge wrote, “It is time to scrap the ‘abnormal working conditions’ doctrine altogether and hold that if there is clear proof of a disabling work-related mental injury, it should be compensable.”

“That concurring opinion is a big deal,” he said. “That judge is essentially saying, as long as somebody has post-traumatic stress disorder, we should look at it as compensable.”

Because the Commonwealth Court established the “abnormal working condition” provision, the court can scrap it, Mr. Kassutto added.