How Presumption Laws Are Changing Workers Compensation

Presumption laws are reshaping how workers compensation insurance works by expanding who is covered, what health conditions are presumed to be work-related and how claims are handled. Once limited to specific roles like firefighters, these laws are now broadening to include more occupations and medical conditions, creating new challenges for employers and insurers.

As the impact presumption laws have on workers comp grows, so do the risks around compliance and the potential related costs. Employers that stay on top of this trend of expanding presumption laws can help ensure they are making good decisions for their employees and their businesses in this evolving legal landscape.

As an example, here’s a case that illustrates how these laws play out in real life: A seasoned firefighter, nearing retirement after decades on the front lines, receives a devastating diagnosis: lung cancer. He has no history of smoking, and no single workplace exposure stands out. Yet under his state’s presumption law, the cancer is considered job-related – shifting the burden of proof to the employer and placing his claim squarely in the workers compensation system.

Scenarios like this are no longer rare. Presumption laws, once narrowly applied, are evolving and quietly reshaping the foundation of workers compensation. Today, all 50 states, the District of Columbia and federal firefighters have some form of presumptive cancer legislation.¹ The trend continues for post-traumatic stress disorder (PTSD), with the National Council on Compensation Insurance reporting in 2024 that it monitored 64 bills related to workers compensation and mental injuries, including 52 addressing compensability for workplace-related mental injuries. Of these, 51 were specifically related to PTSD.²

These laws flip the usual burden of proof by automatically treating certain conditions as job-related unless the employer can prove otherwise.

What is a presumption law – and why it matters in workers compensation

Presumption laws are legal rules that require a court to accept a fact as true without requiring specific proof of that fact unless there is compelling evidence to the contrary. In the context of workers compensation, these laws alter the traditional burden of proof for certain employees by assuming a direct link between their occupation and specific injuries or illnesses.

At its core, workers compensation provides medical care and wage replacement for employees injured on the job, in exchange for employers receiving immunity from civil lawsuits with some noted exceptions. Traditionally, employees making a claim had to prove that their injury or illness was directly related to their job, a process that often requires medical evidence and documentation.

Presumption laws disrupt this model. A “presumption of compensability” means that if a worker in a designated job category, such as a firefighter, police officer or paramedic, develops a condition listed in the statute, it is automatically presumed to be work-related. The burden then shifts to the employer or insurer to disprove that connection. Doing so typically requires demonstrating a lack of occupational exposure or identifying alternative causes, such as tobacco use or a pre-existing medical condition. This can be particularly challenging when dealing with complex illnesses like cancer or mental health conditions such as PTSD.

Because presumption laws vary significantly from state to state in both scope and criteria, multistate employers must navigate a growing maze of compliance obligations and legal interpretations. This evolving legal landscape introduces new layers of risk, uncertainty and potentially financial exposure.

How presumption laws are expanding in workers compensation

Presumption laws were originally enacted to support high-risk public safety roles – particularly firefighters – whose job conditions made certain injuries or illnesses more likely. But in recent years, these laws have expanded significantly. More states are broadening the scope of who qualifies and which conditions are presumed work-related. This shift reflects not only evolving scientific research but also changing societal expectations – especially as younger generations, like Gen Z, bring greater awareness to mental health and demand stronger protections in the workplace. The result: mounting legislative pressure to expand coverage beyond traditional boundaries.

Presumption laws are expanding in two key ways: by covering more occupational roles and by recognizing a broader range of work-related conditions. Here’s how the landscape is evolving:

Occupational categories

Firefighters remain central to most state presumption laws, but legislation increasingly includes:

• Law enforcement
• Paramedics and EMTs
• Healthcare workers

Covered conditions

• Cancers - Many states list specific cancers that are presumed to be job-related. These lists are typically based on occupational exposure research, but the cancers covered vary widely from state to state.
• PTSD & mental health - At least 34 states now allow some form of coverage for mental-only (mental-mental) injuries. A growing number include PTSD presumptions for first responders. Connecticut recently expanded workers compensation coverage and benefits eligibility for PTSD injuries to all employees, not just first responders, though a qualifying trauma event is required.
• Infectious diseases - COVID-19 triggered a wave of temporary and permanent presumption laws for healthcare workers and first responders. Before COVID-19, some states already had presumption laws for occupational diseases like tuberculosis, hepatitis and other blood-borne pathogens.
• Cardiac and respiratory conditions - Particularly for firefighters, several state laws presume that heart and lung diseases are work-related.

What more presumption in workers compensation could mean for employers and insurer

Presumption laws are transforming the rules of workers compensation, potentially raising the stakes for employers. Once limited to firefighters, these protections are now rapidly expanding to cover more occupations, diseases and conditions. As this trend accelerates, employers face growing complexity in risk management, regulatory compliance and potential increased costs.

This advancing legislative trend is more than a regulatory shift. As presumption laws gain ground, the stakes for organizational leaders are rising:

• More claims, higher costs - With the burden of proof reversed, claims that might have been denied under traditional rules are now compensable. This can drive higher claim volume, longer claim durations and increased claim costs, particularly for long-latency illnesses like cancer.
• Rate uncertainty - Workers compensation pricing depends on historical data. But with new presumptions emerging, loss trends may change in ways existing rates do not capture. This makes accurate forecasting more difficult and raises the risk of inadequate reserves.
• Loss-sensitive plans - Employers with large-deductible or self-insured plans face increased volatility. As presumption laws expand, retained losses could rise beyond expectations.
• Claims complexity - Rebutting a presumption often requires extensive medical, occupational and legal investigation. For employers, this means more documentation, longer timelines and increased administrative burden.

Proactive strategies for employers facing expanding presumption laws in workers comp

While expanding presumption laws introduce complexity, employers can take steps now to reduce risk and remain compliant:

1. Stay current - Monitor evolving legislation in every state where you operate. Meet with your legal advisors to help understand potential impacts.
2. Review safety protocols - Assess and mitigate exposure risks tied to common presumption conditions. For example, properly maintain PPE, invest in regular industrial hygiene monitoring and establish an employee feedback program through your safety committee.
3. Prioritize mental health - Proactively support psychological safety through employee assistance programs, training and leadership engagement.
4. Review claims preparedness - Ensure that your team has the tools and expertise to handle presumption-related cases, including documentation and investigative protocols.
5. Understand your policy - Work closely with your insurance advisor or broker to assess how presumption laws might affect your program structure and retention levels.

How presumption laws may change the way workers compensation works

The expanding reach of presumption laws is changing the workers compensation experience. For some employers, what once required proof by a worker may now be presumed.

As presumption legislation proliferates, staying informed is critical. So is having the right support. With more than 100 years of workers compensation expertise and real-time legal and regulatory monitoring, Travelers maintains a deep understanding of presumption laws and the evolving state of workers comp insurance. This is how we are best able to help employers navigate uncertainty, mitigate risk and keep pace with regulatory change.

Reach out to your Travelers representative to understand what these changes could mean for your workers compensation program – and how to move forward with clarity and confidence.

By Jean Tenan – Director on the Travelers Workers Compensation Product Team.

Sources
¹ https://firstrespondercenter.org/wp-content/uploads/2024/11/Firefighter-Presumptive-Cancer-Legislation-in-the-US-Web_FINAL.pdf
² https://www.ncci.com/Articles/Documents/II_Regulatory-Legislative-Trends2024.pdf