June 6, 2023
by Joe Urbanski

New PTSD Presumption for Registered Nurses in Washington

On May 9, 2023, Governor Jay Inslee signed SB 5454 into law further expanding the number of presumptions under the Washington Industrial Insurance Act. SB 5454 provides presumptive coverage under the Industrial Insurance Act to Registered Nurses for Post Traumatic Stress Disorder (PTSD). The new presumption is limited to Registered Nurses as defined in RCW Chapter 18.79 engaged in direct patient care activities and whose PTSD develops or manifests after 90 consecutive days of employment in the State of Washington.

This new presumption is similar to the notorious first responder presumption contained in RCW 51.32.185. First, like the first responder presumption, it exempts Registered Nurses from RCW 51.08.142’s prohibition on stress related mental health conditions being compensable occupation disease. Second, like RCW 51.32.185, the presumption can be rebutted by a preponderance of evidence. Third, the presumption extends for three months following the nurse’s termination of employment for each year of qualifying service up to 60-months (5 years). Finally, and most importantly, like RCW 51.32.185, if there is a decision by the Board that allows the claim for benefits, they will be entitled to recover all of their costs including attorney’s fees. Given these similarities it is likely that the Department will rely heavily on Board decisions regarding RCW 51.32.185 for guidance in complying with the new statute.

To qualify for the presumption the Registered Nurse must only provide direct patient care for 90 consecutive days inside the State of Washington. This is a dramatically shorter period than the 10 years of qualifying service under RCW 51.32.185(5).

This statute goes into effect on January 1, 2024. In preparation for an influx of these claims, employers and third-party administrators must develop processes to carefully evaluate these claims. First, it is important to verify that the claimant meets the bare minimum requirements for presumptive coverage. That is the claimant must both be a Registered Nurse as defined in RCW Chapter 18.79 and have engaged in direct patient care activities for at least 90 days in the State of Washington. If these two conditions are not met, then the claimant does not qualify for presumptive coverage.

However, even if these two minimum conditions are met, the employer should not immediately allow the claim. Claimant must also have had a traumatic event or events which meet the DSM-V criteria for PTSD. Finally, it is important in considering whether to allow the new presumptive claims, to obtain a personal history and complete set of claimant’s medical records particularly past mental health treatment records. The new statute provides that the presumption can be rebutted by a preponderance of evidence that a Registered Nurse’s PTSD is not related to her employment. Thus, it is important to know what the claimed traumatic event is.

Like all new statutes it will take some time to determine how the Department will handle these new presumption claims. If you have any questions regarding this new presumption or a specific matter, do not hesitate to contact me at or by telephone at (971) 867-2724.

Posted by Joe Urbanski.