Washington Department of Labor & Industries Creates Guideline for Post-Traumatic Stress Disorder Claims
Prior to June 2018, all occupational disease claims alleging mental health conditions due to stress were completely barred. However, that changed in 2018 when the legislature created exceptions allowing law enforcement officers and firefighters who met specific criteria to file occupational exposure claims for post-traumatic stress disorder (PTSD). This exception was later expanded to include public safety telecommunicators and registered nurses who met specific criteria.
This led to an influx of PTSD claims, and many have proven difficult to administer both for self-insured employers and the Department itself. In recognition of these difficulties, the Department is in the process of finalizing a treatment guideline that, in its own words, “synthesizes the best available published medical evidence, along with a consensus of subcommittee expertise to clarify Washington State’s L&I’s criteria for treatment of [PTSD].” The guideline was developed by the Department’s Industrial Insurance Medical Advisory Committee and its PTSD Clinical Guideline Subcommittee in partnership with the Department and its Office of Medical Director. The guideline is to be considered a best practice standard for diagnosing and treating injured workers diagnosed with PTSD. In a reassuring statement, the Department’s email distributing the draft PTSD guideline states providers who treat workers with an accepted PTSD claim will be required to follow the guideline as per their signed provider agreement.
The draft guideline can be found HERE.
It is not yet final, however. The guideline was open for public comment through September 12, 2025. Comments can be submitted via mail, facsimile, or email. Details of where to submit comments can be found HERE. The guideline will be presented in an open public meeting on October 23, 2025 and details for that meeting can be found HERE. SBH encourages employers and third-party administrators to review the proposed guideline and submit comment if needed.
What is noteworthy about the guideline is the treatment listed as recommended or covered for treating workers with PTSD. Trauma-focused therapies such as cognitive processing therapy, prolonged exposure, cognitive therapy, eye-movement desensitization and reprocessing, and written exposure therapy are identified as approved treatment for PTSD. Non-trauma focused therapies are also discussed as options when trauma focused therapy is not possible. The guidelines currently state that therapies or treatment options not listed are not recommended or covered as they “lack evidence or efficacy and/or effectiveness in the treatment of PTSD.” This includes Transcranial Magnetic Stimulation and ketamine treatments as they are not covered or approved for treating PTSD.
It is also noteworthy that the guideline provides general direction on treatment duration and intensity. As evidence shows a response to treatment for PTSD can occur early in the treatment process with symptom reduction within the first 6-8 sessions, if improvement is not noted by then, a “conversation” about the non-response should occur and a different form of treatment may be needed. In its current form, the guideline states that if the worker engages in 18-20 sessions and does not respond to treatment, a change in treatment approach or provider must be made.
The guideline further states that there is no reliable evidence to suggest residential treatment facilities provide a significant benefit for treating PTSD, and such treatments are not to be a covered benefit for the treatment of PTSD. The guideline goes on to state that residential treatment is not covered without the presence of safety issues. The guideline does currently include the caveat that residential treatment will be evaluated on a case-by-case basis and requires prior authorization. Only time will tell how strict the Department will be in enforcing this general disapproval of residential PTSD treatment and prior authorization.
These noteworthy items could lead to significant changes in how allowed PTSD cases are administered and what form of treatments are likely to be authorized. The stance on residential treatment alone could prove significant in how PTSD claims are filed and administered.
SBH will be closely following the Department’s next steps in finalizing this guideline and providing employers and third-party administrator’s advice and recommendations based on the guideline’s final form. Please do not hesitate to contact Christine at 503-412-3117 or to discuss the Department’s draft PTSD guideline and what it could mean for allowed PTSD claims.
Posted by Christine Olson.
