Claims adjusters typically handle cases with clear-cut injuries or incidents, but cases involving PTSD, such as that of retired firefighter Todd Nelson, can be more complex due to cumulative trauma with no clear origin or chronology. Firefighters and police officers often experience severe trauma, and the cumulative stress over their entire employment is the main issue, according to a mental health provider.
Nelson, 54, has been fighting for workers’ compensation for almost three years after his suicide attempt. He has spent over $10,000 out-of-pocket for medical care and could face thousands more in legal bills. His case is severe and complex, requiring extended stays in a specialized facility for diagnosis and treatment.
Cal Fire Battalion Chief Brad Niven, who has more than a dozen firefighter friends with similar experiences, said the workers’ compensation system is a “nightmare.” Adjusters are trained to look for ways to deny cases, and the system is adversarial, making it difficult for injured workers to navigate.
Diagnosing PTSD is a complicated process, and firefighters may face challenges in finding a competent therapist who understands the specific challenges of their high-stress job. Living in rural areas can make it even more difficult to find appropriate care.
Cal Fire offers medical coverage through private companies but does not manage medical claims or workers’ comp. The agency has programs to assist employees in finding care, but officials refused to grant an interview and did not answer questions about the problems that their employees face with workers’ comp and mental health issues.
The Nelsons, who have seen the insurance and workers’ comp system from the inside, have few suggestions for fixing it. They are not alone, as lawyers say that the system is based on saving money, is too often adversarial, and deeply entrenched. Even employers who participate in the workers’ comp system say it’s not working well.
The law extending the PTSD presumption for first responders will be revisited when the state Commission on Health & Safety & Workers’ Compensation presents its report on claims and denials to the Senate Committee on Labor, Public Employment and Retirement and the Assembly Committee on Insurance, by the end of this year. However, legislative focus on behavioral health is limited, and managed health care companies are powerful advocates of the status quo.
Leticia Nelson, Todd’s wife, refers to herself as his “service dog” and has devoted untold hours to managing their finances, appointments, and communications with insurers and medical providers. The Nelsons, who want to leave California due to the high cost of fire insurance and the frightening tableau of wildfires, are struggling financially and emotionally. They feel that they have been abandoned by the system and wish for guidance and support.
Nelson still misses his job as a firefighter and shows up at fires in his area, wearing his T-shirt, shorts, and Birkenstocks. He is coming to terms with the devastation his career wrought but still listens to an emergency scanner.
