Mental Injuries Top List for Expanded Workers’ Compensation Coverage

October 15, 2025 | Incident Prevention + Wellness

States are expanding workers’ compensation coverage for mental injuries, occupational cancers, and other work-related conditions. WorkCare helps employers mitigate risk and reduce claim rates with industry-focused, employee-centric solutions.

Work-related mental injuries are emerging as a growing area of concern within the workers’ compensation system. The 2025 Legislative and Regulatory Trends Report released by the National Council on Compensation Insurance (NCCI) in September. This trend is not a surprise given the status of mental health in the U.S. population in September. This trend is not a surprise given the status of mental health in the U.S. population.

Recent surveys show that 67% of American adults are anxious about world events and 47.8 million (18%) have symptoms of depression, a record high. According to the National Alliance on Mental Health, 1 in 5 adults annually experience mental illness, including anxiety disorders, major depressive episodes, and post-traumatic stress disorder (PTSD). Among employed adults, 36% of those surveyed in 2024 said their mental health suffered in the past year due to work-related burnout, an issue increasingly tied to workers’ compensation considerations and legislative attention.

What’s in the NCCI Report

The NCCI is a rate-making service organization and authoritative source of statistically significant workers’ compensation data and insights. Developments detailed in the report, as of July 31, 2025, include:

  • 950 state and federal bills
  • 57 proposed workers’ comp-related regulations
  • 164 bills that have been enacted
  • 65 regulations that were adopted across all jurisdictions

For employers, the report is a valuable workplace health and safety strategic planning tool because it provides a snapshot of trends that are driving changes in federal and state workers’ compensation systems in jurisdictions where they have operations. In addition to a focus on legislative and regulatory responses to PTSD and other mental health disorders experienced by first responders, the NCCI is monitoring:

  • Cancer cases in firefighters
  • Heat-related illness
  • Workplace violence

The NCCI is also tracking the effects of marijuana legalization and increasing receptivity to the use of certain psychedelic substances, health insurance plans available outside of workers’ comp systems, artificial intelligence impacts in the workplace, and the role of independent contractors in the gig economy. (Refer to the report to learn more about these issues.)

While certain occupations are being singled out for attention, they may be precursors to expanded workers’ comp coverage to other workforce populations. Here are some occupational health and safety trends to watch:

1.     Mental injury-related legislation in multiple states: By the end of July, at least 12 state legislatures had considered or were still considering passing bills to establish coverage for first responder claims of work-related PTSD and other types of psychological injuries. A number of other states were considering expansion of existing mental-injury coverage to employees who are not first responders, such as educators and healthcare workers.

Recommended Actions: The trend toward providing compensable coverage for claims of work-related PTSD and other mental health conditions is expected to continue. To be prepared:

  • Monitor the status of mental-injury legislation in applicable jurisdictions.
  • Train employees on ways to respond to threats of violence, mass casualty events, and natural disasters.
  • Provide access to mental health professionals for work-related and personal issues.
  • Offer stress management and wellness education to help employees build resilience.

2.     Cancer presumptions for firefighters: An American Cancer Society study found that firefighters who are exposed to carcinogenic toxins during firefighting and cleanup operations have increased mortality risk for most cancers, including 58% higher risk for skin cancer and 40% higher risk for kidney cancer when compared to non-firefighters. Utah is an example of a state that has enacted comprehensive legislation listing 15 specific cancers as presumptive for firefighters while requiring cancer screening as a preventive measure. 

Recommended Actions: Entities that employ firefighters and first-responder volunteer organizations must ensure that standard safety and health protection procedures are consistently followed. Affected employers are advised to:

  • Monitor toxic-exposure hazards and take steps to mitigate them.
  • Provide personal protective equipment that is fully functional and properly fitted to the wearer.
  • Consistently monitor firefighters’ fitness for duty in accordance with National Fire Protection Association and OSHA standards. Periodic medical surveillance includes, but is not limited to, cancer screening, comprehensive physical exam, blood and urine analysis, pulmonary function, hearing and vision tests, EKG to detect cardiovascular issues, and a chest X-ray (every five years).
  • Provide comprehensive injury prevention and wellness programs to cover all aspects of physical and mental health.

3.     Heat-related Injuries: Awareness of existing and potential impacts of climate change is increasing nationwide, prompting the NCCI to monitor legislation concerning heat-related injuries. Meanwhile, an OSHA indoor and outdoor heat illness prevention standard is in the rule-making stage. Other legislative developments to watch includea bill in California that would establish a disputable presumption for heat-related injuries in agricultural workers. In the U.S. Congress, a proposed bill (HR 3702)would require the Under Secretary of Commerce for Oceans and Atmosphere to conduct an economic impact study on the financial costs of extreme heat. 

Recommended Actions: Exposure to extreme heat and humidity can cause serious illness and death. With or without applicable standards, employers are advised to provide resources to reduce heat illness exposure risks. Illness prevention measures include:

  • Providing access to shade or cooling stations, rest breaks, and water.
  • Allowing time for new and returning employees to acclimatize.
  • Training employees to monitor and respond to signs of heat stress.
  • Adapting schedules to reduce extreme exertion on high heat index days.

4.     Workplace Violence: The NCCI reports that most of the related bills it reviewed referred to the potential for mandatory workplace violence prevention programs. While there are no specific OSHA standards for workplace violence prevention, there are applicable general industry standards.  

Recommended Actions: Workplace violence is a major concern for employers and employees nationwide. According to the Bureau of Labor Statistics, 740 employees died in violent workplace incidents in 2023. The National Safety Council estimates 2 million workers are victims of workplace violence every year. Proactive steps include:

  • Training frontline employees and supervisors to identify risk levels and how to safely de-escalate threats of violence.
  • Checking to see if the state(s) where you have operations have workplace violence prevention laws. These often apply to healthcare facilities.
  • Implementing a workplace violence prevention plan to engage employees in safe behaviors before an incident occurs.
  • Providing human resources and mental health support for victims of subtle or overt harassment, verbal threats, physical assaults, and other acts of violence.

How WorkCare Can Help You Reduce Workers’ Compensation Claim Rates

Workers’ compensation is going through a period of expansion unlike any other in the past decade, driven in part by increasing awareness of mental health conditions, environmental exposures, and the risk of violence in the workplace. At WorkCare, our goal is to help employers address these challenges by delivering industry-specific Incident Prevention + Wellness solutions, immediate Injury Care guidance, and Occupational Health Screening expertise for rapid, accurate medical monitoring.

With WorkCare by your side, your company can identify occupational health exposure risks and respond with targeted solutions. Our customized approach reduces workers’ comp claim rates and OSHA-recordable incidents while providing reassurance to employees that their health, safety, and overall well-being tops your list. Ready to learn more? Contact us today.

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