February 24, 2026: Washington State’s First Responders are Under Threat – Again.
PROTECTING OUR FIRST RESPONDERS
If you’re a firefighter, police officer, EMT, 911 dispatcher, or nurse, you already know that your job can change you. You see scary, painful, and tragic things that most people never have to face. In 2018, Washington State finally recognized this and changed the law so that first responders could more easily get help for PTSD. This meant workers didn’t have to prove, over and over again, that their trauma stemmed from the job.
This change worked. More workers came forward. More people got the PTSD treatment they needed.
But now something else is happening. As the number of PTSD claims grew, the focus inside the system shifted. Instead of focusing on healing, the state began worrying more about costs, pensions, and disability numbers. And now, the Department of Labor & Industries (L&I) and its advisory committee are suggesting new rules that would make it harder for all injured workers with a PTSD diagnosis to get PTSD care.
L&I HAS CREATED A DRAFT GUIDELINE THAT WOULD CONTROL HOW PTSD MUST BE DIAGNOSED AND TREATED.
THE DRAFT INCLUDES RULES THAT:
•Require specific tests: These tools can be helpful, but they may not be appropriate for every claimant and every situation. Clinicians need the flexibility they have under regular health insurance and should not be bound by testing requirements when treating injured workers.
• Limit the number of therapy sessions:The draft guideline only allows certain types of trauma therapy and usually limits them to 12-16 sessions. If a worker doesn’t show certain score changes, they may not get more treatment even if they still need help. This is wrong.
• Block inpatient or residential PTSD treatment: The guideline does not cover inpatient PTSD programs unless someone is in immediate danger. But some first responders need this higher level of care to stay safe and begin healing. LNI claims that studies show inpatient treatment is not effective. This is not true.
THESE GUIDELINES FAIL TO PRIORITIZE HEALING. THEY ARE A WAY FOR L&I TO CHECK BOXES AND GET CLAIMANTS BACK TO WORK QUICKLY. THE PROPOSED GUIDELINES TAKE AWAY FLEXIBILITY, LIMIT TREATMENT CHOICES, AND IGNORE WHAT DOCTORS KNOW THIER PATIENTS NEED.
In January 2026, L&I asked lawmakers to pass HB 2405, which would create a “PTSD pilot program.”
At first, it sounds positive because it would let workers start treatment before their claim is approved. But here’s the truth: The program is built on the same strict guidelines described above. It uses return-to-work results as the main Measure of success. It does nothing to fix the biggest problem: Not enough providers will treat L&I PTSD patients. If workers can’t get an appointment, then no program will help.
HB 2405 passed the House on February 16, 2026, and is moving through the Senate committee process.
I have already submitted official comments against the draft guideline. We are also working to stop HB 2405 unless real access-to-care solutions are included. Our first responders and all PTSD claimants deserve proper and necessary care, not a system designed to save money instead of lives. L&I itself says providers “must follow” the guidelines, meaning they are binding, even when a patient needs something different.
First responders do not choose the horrors they see on the job. But we can choose what kind of help they get afterward. We need a system that truly treats PTSD-not one that just checks boxes. We need more providers, flexible treatment plans, access to inpatient care when needed, and a focus on healing.
The 2018 law didn’t “create” PTSD claims. It simply said that if a longtime first responder develops PTSD, it is likely related to the job. It recognized reality. We fought hard for the PTSD presumption. We cannot let it be undone by new guidelines and pilot programs that look good on paper but close the door on real care. Let’s keep that door open. Let’s protect the people who protect us.
ELIZABETH LEPLEY, ATTORNEY AT LAW