Every state requires employers to pay workers’ compensation to employees who suffer a work-related physical injury that requires medical care or causes the employee to miss a certain amount of work. States take very different approaches to psychological injuries. Florida’s workers’ compensation scheme has evolved in recent years by recognizing that first responders may be entitled to compensation when their work causes them to experience post-traumatic stress disorder (PTSD).

What Is PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition that develops as a response to experiencing or witnessing a traumatic event. Events are typically classified as traumatic when they are shocking, frightening, or dangerous. Observing an accident that maims or kills another person is the kind of traumatic event that might cause PTSD. Natural disasters, engagement in combat, and sexual assaults, or other violent crimes are also examples of traumatic events that could cause PTSD. 

Symptoms of PTSD include:

1. Involuntary and obsessive recall of the traumatic event, often expressed as “I can’t stop thinking about it”’
2. Flashbacks to the traumatic event
3. Social isolation and avoidance of any activity or place that might cause the PTSD sufferer to be reminded of the traumatic event
4. Depression and thoughts of suicide
5. A diminished sense of self-worth
6. Anger, aggression, irritability
7. Reckless behavior

Symptoms of PTSD may appear within days of the traumatic event, but the delayed onset of symptoms is not uncommon. Most people who suffer from PTSD develop symptoms within three months of the traumatic event.

To meet the diagnostic criteria for PTSD, symptoms must persist for longer than one month. Symptoms may last for months or years. 

Most people who develop PTSD also develop a related mental health condition, such as an anxiety disorder, a depressive disorder, or a borderline personality disorder. Talk therapy, either individually or in a group, is a common treatment for PTSD, coupled with the development of coping skills, such as anger management strategies.

At some point in their lives, about 7% of Americans experience PTSD. Combat veterans experience a much higher rate of PTSD, as do firefighters, paramedics, and police officers.

Workers’ Compensation for PTSD

Workers’ compensation is a system that provides benefits to victims of work-related injuries. As a general rule, an employee who is injured while working cannot recover compensation for those injuries in a personal injury lawsuit but is limited to the benefits that workers’ compensation provides.

Damages in personal injury cases generally include compensation for pain, suffering, and emotional distress that is caused by a physical injury. In the absence of a physical injury, damages for emotional distress cannot usually be recovered. A limited exception to that rule apples when emotional distress is intentionally inflicted. Many states have carved out additional exceptions when emotional distress is caused by witnessing a traumatic event that affects a close family member. Some states also make an exception for victims of PTSD and other forms of emotional distress when the victim was physically near the traumatic event.

Workers’ compensation does not award compensation for pain and suffering. When a work-related psychological injury is disabling, whether the worker will be entitled to workers’ compensation disability benefits depends on state law and on the facts of the case. Several states offer no benefits for psychological injuries that are not accompanied by a physical injury. 

The majority of state workers’ compensation laws provide benefits for disabling psychological conditions (such as PTSD) under limited circumstances. Some states limit benefits to psychological injuries that arise from a sudden, unexpected, and extraordinary event. In those states, work-related stress that is an ordinary consequence of the employee’s job cannot create a compensable injury.

A growing trend is to make benefits for PTSD available to first responders, even in the absence of a physical injury. Florida amended its workers’ compensation law in 2018 to join that trend.

Workers’ Compensation for PTSD in Florida

Section 440.093 of Florida’s Workers’ Compensation Act states that a “mental or nervous injury due to stress, fright, or excitement only is not an injury by accident arising out of the employment.” The reality is that mental injuries do arise from employment. Regardless of that reality, the legislature has chosen not to recognize those injuries as work-related.

Florida law also precludes the payment of workers’ compensation benefits for “mental or nervous injuries without an accompanying physical injury requiring medical treatment.” For a mental or nervous injury that arises from a physical injury to be compensable, the “physical injury must be and remain the major contributing cause of the mental or nervous condition.”

Ordinarily, section 440.093 prevents PTSD victims from obtaining workers’ compensation based on work events that cause their condition unless the cause was a work-related physical injury. Bowing to pressure from insurance companies that place profits ahead of insured workers, the legislature also limited the number of months for which temporary benefits for a psychological injury can be paid after the physical injury heals.

PTSD Claims by First Responders

Florida’s restrictions on the payment of benefits are unfair to all victims of PTSD that was caused an event at work, but those restrictions were especially unfair to first responders. Firefighters, paramedics, police officers, and other first responders are more likely than members of other occupations to experience work-related PTSD. Responding to their heroism by denying them workers’ compensation benefits is remarkably unjust.

Fortunately, the Florida legislature stood up to insurance companies in 2018 by expanding workers’ compensation to cover PTSD for first responders. Unfortunately, the legislature placed limitations on the new law that make it less helpful than first responders deserve.

The general rule in Florida allows first responders to obtain medical treatment as a workers’ compensation benefit for mental injuries (other than PTSD) that are not accompanied by a physical injury but does not allow disability benefits unless a physical injury also occurred. The new law allows first responders to obtain disability benefits for PTSD, even in the absence of a physical injury. However, the legislature requires a higher standard of proving PTSD than it requires for proof of other disabilities. 

The legislature also limited the causes of PTSD for which disability benefits are payable. Examples of the eleven eligible causes include seeing witnessing the death of a minor, treating a minor who later dies, or witnessing an act that “shocks the conscience” and causes severe bodily harm. While the limitations mean that some first responders will not receive disability compensation for their PTSD, the law is at least a step in the direction of recognizing that psychological injuries caused by incidents at work can be just ad disabling as physical injuries.