Reforming Workers’ Compensation for Officers with PTSD

SARAH CREIGHTON

Police departments have been battling for decades to get proper care for injured officers through the workers’ compensation (WC) system with very limited or no success for conditions that could be reversed through timely and best-practice care. Despite existing “presumptions” of occupational vulnerabilities and labor codes mandating timely and evidence-based care, maneuvering through the WC system oftentimes exacerbates recoverable conditions because of automatic denials and delays. It creates unnecessary mistrust of leadership and adversarial conditions that result in officers seeking legal representation.

Those who have achieved success in accessing appropriate care are likely the exception and only successful due to proactively developed relationships forged with risk managers, who, in partnership with their police leaders, agreed to work through overly cumbersome and complex legacy policies and practices, regulations, and the labor code.

For those who have achieved success in accessing appropriate care, they are likely the exception and only successful due to proactively developed relationships forged with risk managers, who, in partnership with their police leaders, agreed to work through overly cumbersome and complex legacy policies and practices, regulations, and the labor code. Unfortunately, for many, getting proper care often requires circumventing the WC system entirely, forcing officers to lie about the cause of their condition so they can get timely care through private insurance. While doing so, they absorb the cost of any time off and often deplete their leave banks.

To date, there have been very few successful collaborations or “workarounds,” and they have been mostly limited to physical exposure conditions, illnesses and orthopedic injuries. If those conditions, with little or no stigma, continue to challenge the capabilities of the WC system, how much more difficult is it for an officer who fears the consequences of disclosing an invisible and stigmatized psychological injury or condition like post-traumatic stress disorder (PTSD)?

Labor Code 3212.25 reinforces and provides a robust evidence base, indicating that post-traumatic “injuries” are an occupational hazard caused by a singular significant incident, repeated exposure and/or the cumulative impact of trauma. The intent of the presumption is to recognize the prevalence of evidence and acknowledge that post-traumatic stress is directly attributable to first responder work. The presumption also intends to streamline the process of claim reviews in the interest of officers receiving timely and appropriate care from qualified providers.

Law enforcement agencies are not unique in their inability to access appropriate care. The situation is mirrored in the fire service, as recently highlighted in CalMatters magazine. Adding to an already complicated situation, other organizational barriers reinforce a real fear for officers about losing their careers. There are departments in California today that, once alerted to an officer’s request for help, compel “fitness for duty” evaluations in an attempt to manage or mitigate risk. Sadly, the level of disclosure by an officer required to initiate a claim and be taken seriously through the WC process requires a level of detail about symptoms to justify the condition. Often, the ignorance and fear-based reaction of leadership when a claim is initiated worsens the condition.  As a result, officers either won’t ask for help or delay reporting until their condition is unbearable or completely out of control. Unfortunately, many resort to ineffective coping that directly impacts their work performance, creates behavioral issues, poses serious health and safety threats, and often results in potentially career-ending discipline and dysfunction at home.

When legislative changes dictate how we operate, significant changes are required. Necessary training and restructuring are at the expense of other urgent needs. It’s disruptive, never viewed as optional and compliance deadlines are rarely missed. Watchdogs hover to ensure compliance, and consequences for noncompliance are significant. The same isn’t true for the WC industry. Despite legislative changes, including the potential imposition of penalties for noncompliance (Labor Code 1127), access hasn’t improved. Stakeholders in a position to bring about change continue to perpetuate the status quo, either through misguided intentions or by default. It is egregious that after all the evidence, more first responders continue to die from suicide than in the line of duty because of barriers to receiving timely evidence-based care.

Few agencies in California have developed effective relationships with stakeholders to ensure access to best-practice care. It requires an investment in learning the complexities and dynamics of the WC system and all entities involved to systematically reverse not only the epidemic of PTSI but other reversible conditions of chronic pain and brain injury, routinely left undiagnosed, contributing to further disability. The net result is that best practices accelerate healing and lower the overall cost of claims. It requires a search for best-practice and culturally competent care providers willing to work within an arduous, contentious and often hostile WC system. If you represent a department successful in navigating a collaborative partnership and/or have developed a protocol that accomplishes timely and evidence-based care for your officers, I am looking for your help as I gather current best-practice models to create a template for others and find ways to ensure more accountability.

About the Author

Sarah Creighton is a retired assistant chief from the San Diego Police Department. She can be reached at screighton@institutesofhealth.org.