HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 337 Workers' Compensation Benefits for Posttraumatic Stress Disorder
SPONSOR(S): Constitutional Rights, Rule of Law & Government Operations Subcommittee, McFarland,
Holcomb and others
TIED BILLS: IDEN./SIM. BILLS: SB 352
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY
CHIEF
1) Insurance & Banking Subcommittee 18 Y, 0 N Fletcher Lloyd
2) Constitutional Rights, Rule of Law & 14 Y, 0 N, As CS Villa Miller
Government Operations Subcommittee
3) Appropriations Committee 25 Y, 0 N Perez Pridgeon
4) Commerce Committee
SUMMARY ANALYSIS
Workers’ compensation laws require employers to pay medical and indemnity benefits if an employee suffers
an accidental injury or death arising out of work performed in the course and scope of their employment.
Employer-paid benefits for a nervous or mental injury are typically allowed only if an employee suffers a
physical injury that triggers a mental injury.
The Legislature created statutory exceptions for certain first responders in 2018, making Posttraumatic Stress
Disorder (PTSD) a compensable occupational disease for firefighters, paramedics, emergency medical
technicians, and law enforcement officers who suffer from PTSD after experiencing certain types of qualifying
events, even though they were not physically injured.
In 2022, the Legislature extended benefits to correctional officers who experience certain qualifying events and
are subsequently diagnosed with PTSD due to their job duties.
The bill extends PTSD benefits to 911 public safety telecommunicators and crime scene investigators that are
diagnosed with PTSD after experiencing certain qualifying events, like witnessing a death or grievous bodily
injury, or verbally aiding a person who dies during a state of emergency because first responders cannot be
dispatched.
The bill has an indeterminate, potentially significant, negative fiscal impact on local governments and an
unknown, but likely small, fiscal impact on state government.
The bill provides an effective date of July 1, 2023.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Current Situation
Diagnosis of Posttraumatic Stress Disorder
According to the American Psychiatric Association, Posttraumatic Stress Disorder (PTSD) is a psychiatric
disorder that may occur in people who have experienced or witnessed a traumatic event, such as a natural
disaster, serious accident, terrorist act, war, or rape; or people who have been threatened with death,
sexual violence, or serious injury.1 Exposure to an upsetting traumatic event may be indirect rather than
first hand. PTSD can occur if a person learns of the violent death of a close family member or friend, or is
repeatedly exposed to the horrible details of trauma.2
Symptoms of PTSD may begin shortly after the traumatic event, or may not appear until years after the
event. For a person to be diagnosed with PTSD, symptoms must last for more than one month and must
cause significant distress or interfere with the individual’s daily functioning. 3
Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts
about the event. This can lead to avoidance of any stimuli that recalls the traumatic events, negative
thoughts about oneself or the world, and changes in emotional reactions to events, like being easily startled
or having trouble sleeping or concentrating.4
Rates of PTSD are higher among veterans, police officers, firefighters, and emergency medical personnel. 5
Florida Workers’ Compensation System
Workers’ compensation is a no-fault system that provides medical benefits and compensation for lost
wages when an employee is injured or killed in the course of employment. Employers must secure
coverage, and may do so by purchasing insurance from an authorized carrier, qualifying as a self-insurer,
or purchasing coverage from the Florida Workers’ Compensation Joint Underwriting Association, which is
the state-sponsored insurer of last resort. In return for providing compensation, the employer is relieved of
civil tort liability for workplace injuries, and may only be sued for intentional acts that result in injury or
death.6
In addition to on-the-job injuries, employers may be required to pay compensation or furnish benefits if an
occupational disease causes death or disablement. 7 In general, an occupational disease is compensable if:
A condition peculiar to the occupation causes the disease;
Epidemiological studies show exposure to a specific substance involved, at the levels to which the
employee was exposed, may cause the disease;
The disease is the result of the nature of the employment, meaning the occupation presents a
particular hazard of the disease or the incidence of the disease is substantially higher in the
1 American Psychiatric Association, What is Posttraumatic Stress Disorder (PTSD)?, https://www.psychiatry.org/patients-
families/ptsd/what-is-ptsd, (last visited Mar. 6, 2023).
2 Id.
3 Id.
4 Mayo Clinic, Post-traumatic stress disorder (PTSD), https://www.mayoclinic.org/diseases-conditions/post-traumatic-
stress-disorder/symptoms-causes/syc-20355967 (last visited Mar. 6, 2023).
5 Institutes of Public Health, PTSD in First Responders, https://institutesofhealth.org/ptsd-in-first-responders (last visited
Mar. 6, 2023).
6 Ss. 440.015, 440.09, 440.10, 440.38, and 627.313, F.S.
7 S. 440.151(1), F.S.
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occupation than in the public;
The disease is contracted during the course and scope of employment; and
The nature of the employment is the major contributing cause of the disease, meaning the cause is
more than 50% responsible for the disease as compared to all other causes combined, as
demonstrated by medical evidence only.8
Benefits for Temporary and Permanent Disability
An employer must pay compensation or furnish benefits if an employee suffers a compensable injury or
death “arising out of work performed in the course and scope of employment.” 9
Medical Benefits
Employees are entitled to receive all medically necessary remedial treatment, care, and attendance,
including medications, medical supplies, durable medical equipment, and prostheses, for as long as the
nature of the injury and process of recovery requires.10
Indemnity Benefits
Payments for lost wages, known as indemnity benefits, may be required if an injured employee is unable to
work, as determined by an authorized treating medical provider, and typically begin on the eighth day after
the employee loses time from work.11 Indemnity benefits fall into four categories:
Permanent Total Disability – In the case of total disability adjudged to be permanent (i.e., the
employee is unable to engage in any type of employment), the employer or its insurance carrier
must pay two-thirds of the employee’s average weekly wages until the employee reaches the age of
75.12
Temporary Total Disability – In the case of disability total in character but temporary in quality, the
employer or its insurance carrier must pay two-thirds of the employee’s average weekly wages until
the employee returns to work or reaches maximum medical improvement, but in no event more
than 260 weeks (five years).13
Permanent Impairment – Where an employee has reached maximum medical improvement, is
able to return to work, but has a permanent, but partial, physical impairment, the Three-Member
Panel14 establishes and uses an impairment rating schedule which represents a percentage of
disability to the body as a whole; a monetary benefit is calculated based on the percentage of
impairment.15
Temporary Partial Disability – Where an employee may work with restrictions, the employer or its
insurance carrier must pay 80% of the difference between his or her weekly earnings prior to injury
and post-injury. Payments may be required for up to 260 weeks.16
The minimum payment is $20 per week and the maximum payment is 100 percent of the statewide
average weekly wage, which is based on the average weekly wage paid by employers’ subject to the
Florida Reemployment Assistance Program Law as reported to the Department of Economic Opportunity. 17
Payments to injured workers who earn more than the statewide average weekly wage are capped at the
8 Ss. 440.09, and 440.151, F.S.
9 S. 440.09(1), F.S.
10 S. 440.13(2)(a), F.S.
11 Ss. 440.14(1), and 440.20(2)(a), F.S.
12 S. 440.15(1), F.S.
13 S. 440.15(2)(a), F.S., limits disability benefits to 104 weeks (two years), but the Florida Supreme Court held that this
limit was unconstitutional and directed that a prior limit of 260 weeks (five years) be reinstated. See Westphal v. City of St.
Petersburg, 194 So. 3d 311 (Fla. 2016).
14 The Three-Member Panel consists of the Chief Financial Officer, or his or her designee, and two members appointed by
the Governor, subject to confirmation by the Senate. S. 440.13, F.S.
15 S 440.15(3), F.S.
16 S 440.15(4), F.S.
17 S. 440.12(2), F.S.
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statewide average weekly wage that was in effect on the date of injury. 18
General Rules of Compensability for Mental or Nervous Injuries
Mental or Nervous injuries may be compensable, but only if the injury is accompanied by a physical injury
that requires medical treatment. Thus, if a workplace accident causes both a physical injury and a related
mental or nervous injury, both may be compensable so long as the physical injury that requires medical
treatment is the major contributing cause (at least 50 percent responsible) of the mental or nervous injury.
A mental or nervous injury caused by “stress, fright, or excitement” is not compensable. 19
As discussed above, an employee who is temporarily disabled by a workplace injury is eligible for up to 260
weeks of disability benefits, which typically results in payment of about two-thirds of the employee’s regular
wages, beginning on the eighth day after the employee loses time from work.20 However, temporary
disability benefits caused by a mental or nervous injury are limited to six months after a claimant reaches
maximum medical improvement for the physical injury that triggered the mental or nervous injury. 21
For employees who are not first responders, benefits for mental or nervous injuries: 1) may last no longer
than six months from the date of the maximum medical improvement from the physical injury, 22 and 2) may
not exceed the 1 percent limit on permanent psychiatric impairment benefits.23
Special Rules for First Responders
The 2007 Law
The Legislature recognized the unique occupational hazards associated with the work of first responders in
2007 by providing additional coverage for employment-related accidents and injuries of both paid and
volunteer firefighters, emergency medical technicians and paramedics, and law enforcement officers. 24 The
law relaxed certain standards to make it easier for first responders to obtain workers’ compensation
benefits.
For mental and nervous injuries, lawmakers:
Authorized medical benefits for first responders who did not suffer a physical injury but
demonstrate, by clear and convincing evidence, that a mental or nervous injury arose out of
employment;
Authorized indemnity benefits (lost wages) for first responders who demonstrate that a mental or
nervous injury arose out of a physical injury suffered during the course of employment; and
Exempted first responders from limits that typically apply to temporary disability benefits for mental
and nervous injuries.
For occupational diseases, lawmakers:
Reduced the evidentiary burden for claims of occupational disease due to exposure to a specific
toxic substance, requiring proof of causation by a preponderance of the evidence, rather than the
clear and convincing evidentiary standard typically applied to such claims; and
Eliminated the requirement that a first responder’s claim of occupational disease be supported by
epidemiological studies showing that exposure to the specific substance involved, at the levels to
18 Id.
19 S. 440.093, F.S.
20 See supra note 13.
21 S. 440.093(3), F.S.
22 S. 440.093, F.S.
23 S. 440.15(3(c), F.S.
24 Chapter 2007-87, Laws of Florida, created s. 112.1815, F.S.
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which the employee was exposed, may cause the precise disease sustained by the employee.
Additionally, lawmakers:
Created a presumption that any adverse reaction to a smallpox vaccination administered to a first
responder is a compensable accident; and
Required that permanent total supplemental benefits received by a first responder whose employer
does not participate in the Social Security program shall not terminate when the first responder
reaches age 62.
2018 Amendments
In 2018, the Legislature authorized medical benefits and compensation for lost wages for first responders
who are diagnosed with PTSD (as described by the Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition, published by the American Psychiatric Association).25
As a result, a first responder who experiences one of the following qualifying events need not suffer a
physical injury to qualify for medical benefits and be compensated for lost wages:
Seeing a deceased minor;
Witnessing the death of a minor;
Witnessing an injury to a minor who subsequently dies before or upon arrival at a hospital
emergency department;
Participating in the treatment of an injured minor who dies before or on arrival at a hospital
emergency department;
Transporting an injured minor who dies before or on arrival at a hospital emergency department;
Seeing a decedent whose death was due to grievous bodily harm of a nature that shocks the
conscience;
Witnessing a death (including suicide) that involved grievous bodily harm of a nature that shocks
the conscience;
Witnessing a homicide, whether criminal or excusable, including murder, mass killing,
manslaughter, self-defense, misadventure, and negligence;
Witnessing an injury (including an attempted suicide) to a person who dies before or upon arrival at
a hospital emergency department if the person was injured by grievous bodily harm of a nature that
shocks the conscience;
Participating in the treatment of an injury (including attempted suicide) to a person who dies before
or upon arrival at a hospital emergency department if the person was injured by grievous bodily
harm of a nature that shocks the conscience; or
Transporting a person who was injured (including by attempted suicide) who dies before or upon
arrival at a hospital emergency department if the person was injured by grievous bodily harm of a
nature that shocks the conscience.
2022 Amendments
In 2022, the Legislature authorized medical benefits and compensation for lost wages for correctional
officers who are diagnosed with PTSD. As a result, a correctional officer who experiences one of the
following qualifying events need not suffer a physical injury to qualify for medical benefits and be
compensated for lost wages:
Being taken hostage by an inmate or trapped in a life-threatening situation as a result of an inmate's
act;
Directly witnessing a death (including a death due to suicide) of a person who suffered grievous
bodily harm of a nature that shocks the conscience;
Directly witnessing an injury (including an attempted suicide) to a person who subsequently dies
before or upon arrival at a hospital emergency department if the person was injured by grievous
25 Chapter 2018-124, Laws of Florida, amended s. 112.1815, F.S.
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bodily harm of a nature that shocks the conscience;
Participating in the physical treatment of an injury, or manually transporting a person who was
injured (including by attempted suicide) who subsequently dies before or upon arrival at a hospital
emergency department if the person was injured by grievous bodily harm of a nature that shocks
the conscience;
Directly witnessing a homicide regardless of whether the homicide was criminal or excusable,
including murder, mass killing (three or m