The National Council on Compensation Insurance (NCCI) published Firefighters and First Responders: 2023 Update on Presumptive Workers’ Comp Benefits, a new research brief that reviews recent legislative developments surrounding presumptions for firefighters.
Healthe recently reported on the high volume of PTSD bills introduced so far in 2023, but NCCI’s new brief explores not only PTSD, but also cancer presumptions, lung/respiratory conditions, heart/vascular conditions, and blood and infectious diseases. Additionally, NCCI reviews other factors such as how volunteer firefighters are treated, potential shifts in coverage, service requirements, restrictions, health evaluations, and more.
Of the 38 jurisdictions that NCCI overviews, 20 have presumptions for firefighters diagnosed with one of several types of cancers. Some jurisdictions use broad definitions of cancer, while others list specific types of cancer that are covered under workers’ comp.
According to data reported to NCCI, approximately 180 firefighter cancer claims were filed since 2004, with three-fourths of them coming from Colorado, Louisiana, Maryland, and Oregon. The report notes legislative changes made in the last few years within these states, which have allowed more cancer claims to be approved.
In one point of interest, among Texas cancer claims filed by firefighters, over 90% were denied. Many claimed that a memo from the Texas Intergovernmental Risk Pool only presumed three types of cancer. A 2019 law officially recognized 11 types of cancer, which may lead to greater acceptance of these claims.
Approximately 18 jurisdictions had some kind of presumptive coverage for lung or respiratory conditions. However, nine of those jurisdictions will only provide coverage if the firefighter in question is a non-smoker and/or a non-tobacco user.
A total of 13 jurisdictions offered presumptive coverage for infectious and bloodborne diseases. As firefighters often aid at the scene of traumatic events such as car accidents, they can be exposed to such diseases when helping victims of such events. In fact, the National Fire Protective Association estimates 20,900 firefighters were exposed to some kind of infectious disease in 2020.
These presumptions primarily cover HIV/AIDs, hepatitis, tuberculosis, and meningococcal meningitis. In regard to COVID-19, many states passed presumption laws in 2020 and 2021, but those laws had expiration dates or sunset provisions tied to the end of the state of emergency.
Of the 38 jurisdictions, 19 offered presumptive coverage for heart and vascular conditions, typically for hypertension and heart disease. However, there was significant complexity across legislation, as proving that these conditions were primarily brought about by occupational factors is difficult.
Many states specifically state that coverage for these conditions requires physical exertion or mental stress beyond the scope of normal duties; as the scope of normal duties for firefighters is already incredibly high, actions that constitute going beyond such a scope is particularly vague.
Of note, sudden cardiac death (usually from a heart attack) was the most common cause of on-the-job death for firefighters in 2021, accounting for half of such fatalities.
Regarding mental-mental injuries, 25 jurisdictions provided coverage for PTSD and other mental illnesses that were caused by incidents on the job.
Key points made by report also include:
- Many presumptions require a minimum number of years to qualify for presumptive coverage, ranging from 2-12 years depending on disease
- Volunteer firefighters are not always covered by these presumptions, and even when they are, the question of risk level is discussed when compared to career firefighters
- Many firefighters work for self-insured municipalities that are not required to report data to NCCI, meaning only a portion of firefighter claim history is available