Signed into law on October 29, 2024, Act 121 amends Pennsylvania’s Workers’ Compensation Act to address mental health coverage for first responders, specifically focusing on post-traumatic stress injury (PTSI), often referred to as “PTSD.” It will take effect on October 29, 2025.
Provisions apply to claims filed on or after October 29, 2025, and injuries occurring within five years before that date (October 29, 2020).
Act 121 allows first responders, including firefighters, police officers, and emergency medical services personnel, to file workers’ compensation claims for PTSI resulting from exposure to traumatic events in the course of their employment.
The law does not create an automatic presumption that PTSI is work-related (unlike California’s SB 542). Instead, first responders must still demonstrate that their PTSI is directly related to their job duties.
The act clearly defines which occupations are covered, including paid and volunteer firefighters, law enforcement officers, and EMS personnel.
First responders in Pennsylvania now have a clearer and broader path to seek workers’ compensation benefits for PTSI, but they must provide evidence linking their condition to a work-related traumatic event.
Unlike some other states, Pennsylvania requires proof of causation; the burden remains on the employee to show the connection between their mental health condition and their work.
The law recognizes the unique mental health challenges faced by first responders and aims to support them in accessing care and benefits.
Pennsylvania courts recognized mental-mental injury claims (where a psychological injury arises without a physical injury) could be compensable. However, the burden of proof was high and there was no presumption, which made it especially difficult for first responders. Claimants had to show:
Act 121 removes barriers, making PTSI claims for traumatic exposure on the job significantly more viable and accessible. The Act does not create a presumption but removes the “abnormal working conditions” barrier and defines “qualifying traumatic events” for which claims can be made.
| BEFORE ACT 121 | AFTER ACT 121 |
|---|---|
| • PTSI claims theoretically possible but rarely successful • Burden of proof: show abnormal stress • No presumption of work-relatedness • Claims often dismissed as stress was “normal” for the job | • Claims allowed without needing to prove “abnormal working conditions” • Burden of proof: show a traumatic work event • Still no presumption, but standard is less restrictive • Traumatic event + diagnosis by licensed provider = viable path to claim |
TPA Clear Designation
Ensure your third-party administrator (TPA) is fully briefed on Act 121 and has a clear process for designating, coding and tracking PTSI claims. This will help ensure these claims are handled consistently and in compliance with the law.
Expansion of Injury Reporting Forms
Consider updating or expanding your injury/incident reporting forms to specifically include mental health and PTSI-related questions (to include trauma related and psychological exposures). This can help capture relevant details early and support proper documentation for Act 121 claims.
Review Union Contracts
Review collective bargaining agreements to identify any provisions related to mental health, workers’ compensation, or return-to-work (RTW) policies. Ensure that your approach to Act 121 claims aligns with contractual obligations and that union representatives are informed about the new law.
Supervisor Training
Train supervisors and managers to recognize signs and symptoms of PTSD/PTSI and to understand the requirements of Act 121. This includes knowing how to respond to reports of traumatic incidents and how to support affected employees.
Wellness Programs
Enhance or implement wellness programs that address mental health, resilience, and stress management. Promote resources such as employee assistance programs (EAPs), peer support, and confidential counseling services.
Prompt Independent Medical Evaluation (IME)
Arrange for an IME as soon as possible when a PTSI claim is filed. Early evaluations can help clarify diagnosis, causation, and treatment needs, and may assist in managing claim duration and costs.
Monitor Medical Progress
Closely track the claimant’s medical progress and compliance with prescribed treatment. Maintain regular communication with treating providers to ensure appropriate care and timely updates.
Review Offsets
Evaluate whether benefits from other sources—such as disability insurance or pension plans—may offset workers’ compensation payments. Coordinate with your TPA and legal counsel to ensure proper application of offsets.
Return-to-Work (RTW) Options
Explore RTW opportunities, including light-duty assignments for employees recovering from PTSI. Work with medical providers to determine appropriate accommodations and facilitate a safe, supported transition back to work.
Early Intervention and Communication
Upon notice of a traumatic event or claim, reach out to the employee promptly to express support, explain the process, and provide information about available resources.
Dedicated Claims Contact
Assign a dedicated claims manager or point of contact for PTSI claims to ensure consistency, build trust, and facilitate communication between all parties.
Documentation and Recordkeeping
Encourage thorough documentation of all potentially traumatic incidents, including date, time, location, involved parties, and immediate response actions. Maintain claim files and keep organized records of all communications, medical reports, witness statements, and investigative materials related to each claim.
Data Analysis and Trend Monitoring
Track claim trends and analyze data on PTSI claims to identify patterns, root causes, and opportunities for prevention or process improvement.
Course of Employment
Assess whether the reported traumatic event(s) occurred in the course and scope of employment. Gather incident reports, duty logs, and witness statements to confirm work-relatedness.
Disability Status
Review medical evidence to determine if the employee is totally disabled or capable of performing light-duty work. If medical records support eligibility for modified duty, document this and offer appropriate accommodations.
Surveillance and Background Checks
Where appropriate and lawful, consider surveillance or review of pre-employment and medical records to assess the validity of the claim and identify any pre-existing conditions or non-work-related factors.
Conflicting Medical Reports
If there are discrepancies between medical opinions regarding the diagnosis, severity, or timeline of PTSI, obtain additional expert opinions or request clarification from treating providers.
Witness Statements
Collect statements from coworkers, supervisors, and others who may have observed the incident or the employee’s behavior before and after the alleged traumatic event. These can be critical in establishing facts and timelines.
Partner, Managing Account Executive, Underwriting Manager Public Entity Practice
