First Responders’ Psychiatric Injuries in West Virginia

Compliance Corner

Under West Virginia workers' compensation law, no alleged injury or disease may be recognized as a compensable injury or disease if it was solely caused by nonphysical means and did not result in any physical injury or disease to the person claiming benefits.

However, as Simply Research readers know, an exception extends workers' compensation coverage to first responders. Here's how it works.

Glossary Check

"First responder" means a law enforcement officer, firefighter, emergency medical technician, paramedic, and emergency dispatcher.

"Post-traumatic stress disorder" means a disorder that meets the diagnostic criteria for post-traumatic stress disorder specified by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, or a later edition as adopted by rule of the insurance commissioner.

"Licensed mental health provider" means a licensed psychiatrist, licensed psychologist, licensed professional counselor, licensed marriage and family therapist, certified mental health nurse practitioner, certified psychiatric physician assistant, or licensed social worker who:

+ Holds a master's degree or higher.

+ Holds a terminal license within their profession.

+ Is qualified to treat post-traumatic stress disorder.

"Employer" means any entity that controls, consistent with the provisions of West Virginia law relating to an employment relationship, the paid or volunteer employment of a first responder eligible for benefits under this section.

'Occupational Hazard'

West Virgina workers' compensation law considers post-traumatic stress disorder a unique medical condition. Although it may manifest itself as a psychiatric condition that would be otherwise precluded from workers' compensation coverage, post-traumatic stress disorder is an occupational hazard for first responders, similar to members of the military serving in combat.

Because first responders are required to expose themselves to traumatic events during the course of their employment and thus are at a recognized higher risk of developing post-traumatic stress disorder, and because of the severe nature and debilitative effects of post-traumatic stress disorder, the state to permits coverage to this class of individuals for their work-related disease.

PTSD Compensability

Post-traumatic stress disorder suffered by a first responder may be recognized as a compensable occupational disease under West Virgina law when:

+ The employer has elected to provide coverage for post-traumatic stress disorder as an occupational disease; and

+ A diagnosis has been made by a licensed psychiatrist, certified mental health nurse practitioner, or certified psychiatric physician assistant that the first responder suffered from post-traumatic stress disorder due to exposure to an event or events that occurred in the course of and resulting from the first responder's paid or volunteer covered employment.

Who can Provide Treatment?

While the diagnosis must be made by a licensed psychiatrist, certified mental health nurse practitioner, or certified psychiatric physician assistant, mental health treatment consistent for a post-traumatic stress disorder diagnosis may be offered by a licensed mental health provider other than the diagnosing psychiatrist, certified mental health nurse practitioner, or certified psychiatric physician assistant.

Doesn't Extend to Personnel-Related Actions

A diagnosis of post-traumatic stress disorder under this section may not include consideration of any layoff, termination, disciplinary action, or any similar personnel-related action taken in good faith by an employer.

Coverage Issues

Benefits for a post-traumatic stress disorder diagnosis made under this section are contingent upon the employer electing to provide coverage for post-traumatic stress disorder from its workers' compensation insurance carrier or to provide for it through its self-insurance program, whichever is applicable.

Timelines

The receipt of benefits is contingent on a claim being made within three years from and after a licensed psychiatrist, certified mental health nurse practitioner, or certified psychiatric physician assistant has made the claimant aware of a post-traumatic stress disorder diagnosis.

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