Washington Legislature Passes PTSD Pilot Project Set to Apply to State Fund Employers and Participating Self-Insured Employers
In 2018, the Washington legislature passed SB 6214 which created what has become known as the PTSD presumption amendments for first responders. This presumption was later expanded to include direct care registered nurses in 2024. These amendments have resulted in claims that have proven costly for both state funded and self-insured employers, leading the Department to explore ways to help adjudicate PTSD presumption claims that not only ensure first responders and direct care registered nurses receive the benefits they are entitled to under a compensable PTSD presumption claim but also aim to appropriately close/resolve claims.
One such effort is reflected in the recently passed PTSD Pilot Project that the Washington State Governor Bob Ferguson is anticipated to sign into law. Once Governor Ferguson signs it, this bill will become effective on July 1, 2026. Currently, self-insured employers are not required to participate in the pilot project, but may elect to do so.
The key focus of this pilot program applies to state fund employers and voluntarily participating self-insured employers. The idea behind this aspect of the pilot project is to allow workers who file PTSD presumption claims to access mental health treatment prior to claim adjudication regardless of whether the claim is ultimately allowed while also providing an opportunity to seek a limited amount of post-closure mental health treatment. The hope is that this access to early and post-closure treatment will help improve recovery outcomes that enable sustained work.
Under the pilot project, if a worker elects to include their claim in the program, the Department and participating self-insured employers shall authorize a diagnostic interview and up to eleven authorized mental health treatment appointments within 90 days of diagnosis with a mental health provider qualified to provide such treatment regardless of claim compensability. If the claim has not been allowed within 90 days, an additional twelve treatment sessions can be approved by the supervisor of industrial insurance. If the claim is ultimately denied, pre-adjudication treatment costs are paid by the self-insurer and for state fund claims, pre-adjudication treatment costs for claims that are later denied are to be spread across all risk classes that the PTSD presumption amendments apply to.
This pilot project also permits workers who file a PTSD presumption claim to seek and obtain pre-adjudication treatment from a qualified mental health professional regardless of whether they are a member of the Department’s Medical Provider Network if the provider meets qualifications and requirements the Department establishes. Once the claim is allowed, the worker must seek treatment from a provider in the Department’s Medical Provider Network.
Further, the pilot project requires the Department and participating self-insured employers to authorize up to six additional treatment sessions within one year of claim closure if the additional treatment is deemed necessary to maintain a worker’s level of functioning once the claim closes.
Since treatment authorization is required as part of this pilot project, a Maphet safeguard is built into this pilot project bill as paying for treatments under this new statutory framework “shall not be considered a binding determination of the obligations” on the Department or self-insured employer.
Participating self-insured employers must produce a report of all workers’ compensation claims subject to the pilot project if such a report is requested. The bill also creates a July 1, 2030 deadline by which the Department is tasked with providing recommendations of whether the pilot program or behavioral health program should be extended or expanded, whether statutory or policy changes are needed to support a broader implementation of this program, and whether potential incentives or program changes that provide measurable benefits to workers and employers. The bill is set to expire on December 31, 2030.
Whether this pilot project succeeds in achieving its goals is something the Department, self-insured employers with workers eligible to file PTSD presumption claims, and SBH will be closely monitoring over the upcoming years. If you are a self-insured employer with employees who fall under the PTSD presumptions or third-party administrator who handles PTSD presumption claims and have questions about whether participating in this pilot project could prove beneficial or have questions about PTSD claims in general, please do not hesitate to contact me at 503-412-3117 or .
Posted by Christine Olson.
