High denial rate for presumptive PTSD claims, low return to work: Report

Claims for post-traumatic stress disorder in Minnesota presumed to arise from employment are denied at a greater rate than those for which the worker is required to prove compensability, according to a state report.

The report also showed that workers covered by the PTSD presumption return to work at a lower rate than those not covered by it.

PTSD is a recognized occupational disease in Minnesota. Since Jan. 1, 2019, it is also presumed that the condition arose from employment for law enforcement, firefighters, paramedics and EMTs, licensed nurses providing emergency medical services outside of a medical facility, dispatchers and correctional officers.

Insurers and employers issued an initial denial of primary liability for more than 90% of all PTSD claims filed between 2014 and 2023, the state’s Department of Labor and Industry said. The denial rate for PTSD claims is higher than any other category of injury not related to COVID-19, none of which exceeded 20% during the study period.

The department also reported that the initial denial rate did not decrease when the presumption took effect and that “initial denial rates for PTSD claims among presumption workers exceeded those among non-presumption workers each year from 2017 onward.”

The high denial rates result from factors that include uncertainty about the date of injury — whether it’s the date of exposure, diagnosis first treatment or last — and other requirements for coverage, the department said.

For example, workers must be diagnosed with PTSD by a licensed psychologist or psychiatrist after experiencing at least one month of persistent symptoms, as required by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5.

Requiring a month of persistent symptoms isn’t consistent with current statutory timelines that were drafted for physical trauma, the department said. Current deadlines require a worker to report an injury within 14 days, the employer to submit a report of injury within 10 days, and the insurer to accept or deny the claim within 14 days.

Also, workers who are required to prove they developed PTSD through employment return to work at a far greater rate than those whose employers have to prove they didn’t develop PTSD at work, the department reported.

“Four in five PTSD claims by non-presumption workers resulted in the workers returning to work within a year after the claims closed,” the department said. “However, return-to-work rates were lower among presumption occupation workers, dropping to below 60% after the presumption. The decrease in the return-to-work rate among presumption workers was driven mainly by police officers, the largest occupation group among presumption workers in this study.”

Among other things, the report recommends standardizing the date of injury for PTSD and aligning PTSD claim timelines around the diagnosis date.

The report also suggests allowing more providers to diagnose the condition to enable “more effective claim processing and treatment access” and expanding the list of acceptable treatments.

The PTSD laws for first responders, specifically, have worked “too well in some ways and too poorly in others,” said a 2024 article published in a student-run journal at the Mitchell Hamline School of Law in St. Paul, Minnesota.

The system is efficient when it comes to granting work comp and duty disability benefits, the article said. But officers receive too many benefits in too short a time from a system that is “ill-equipped” to determine whether they’ve reached maximum medical improvement.

The law school journal article recommended that “the nature of PTSD as an injury should be narrowed to the triggering event”; making PTSD compensability contingent upon specific triggering events; eliminating the presumption for law enforcement but mandating paid leave and treatment; defining maximum medical improvement for PTSD claims; and disallowing coverage for police officers fired for misconduct.

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