Over the last several years, many states have attempted, and some have passed, legislation focused on providing workers’ compensation coverage and protections for first responders (firefighters, emergency medical technicians, police officers, paramedics, etc.) for conditions such as cancer, cardiac health and stress. In 2025, this trend continues including several new “presumptive” coverage bills.
Benefit-of-the-doubt presumptive coverage
Several state bills this year address presumptions, which shift the burden of proof of an illness from the claimant/first responder to the employer when determining if a claim is compensable. Presumptive coverage legislation is based on the fact that, due to their occupations, first responders are statistically more likely to be at risk for certain illnesses/conditions even though it can be difficult to conclusively prove the illness/condition resulted from the workplace and not factors outside of the job.
Expansion of these laws means greater access to care for first responders. Due to the types of conditions/illnesses they cover, it also means increased claims and higher costs for employers.
- Claims for mental health issues such as post-traumatic stress disorder (PTSD) often require different and longer-duration treatments than physical injury claims.
- Cancer treatment medications can be costly and are often prescribed with additional medications to manage treatment side effects. (You can find more information on this in our article, “Helping Heroes Fight Cancer.”)
A busy year for special coverage
MyMatrixx has been tracking over 70 bills since January 1 that either expand, clarify, or amend special or presumptive coverage.
A 2025 New York bill, S 755, actually reverses S 6635, a bill passed in late 2024. S 6635 expanded the coverage for stress-related claims from just first responders to all workers, stating that the Workers’ Compensation Board may not disallow a claim based on that worker’s stress was not greater than the stress occurring in a normal work environment.
In early February 2025, S 755 was passed and signed into law and now limits those coverage provisions to only certain first responders in relation to a work-related emergency (not all workers). It also adds that first responders must demonstrate the disorder arose out of extraordinary work-related stress attributable to a distinct work-related event or events directly related to the employment and occurring during the performance of job duties.
Over a dozen related bills have already failed in three states this year: Mississippi, North Dakota, and Virginia. These included bills which would have expanded mental stress, heart, lung, and/or cancer coverage in first responders and, in at least one case, correctional officers.
A majority of the special or presumptive coverage bills are still pending in about half of the states but will evolve over the next few months. A list of these bills and details of their current status can be found on our Legislative and Regulatory Policy Tracker on our Statehouse Watch webpage. On the page, you can sort bills by topic and state, and if you select the “Presumption” topic from the tracker menu you can view most of these bills.
MyMatrixx tracks it all
MyMatrixx continues to track and monitor the growing list of legislation for impacts both legislatively and clinically. We will stay ahead of presumption legislative activities and help manage the resulting medications for the benefit of both the injured worker and the payer.
Questions on these bills or other public policy topics for our Regulatory Affairs team can be sent to MMXRegulatoryAffairs@MyMatrixx.com. For more information on policy developments in workers’ compensation impacting pharmacy across the country, please visit and bookmark Statehouse Watch at MyMatrixx.com.