Workers’ compensation was built for injuries that show up on an X-ray. A fracture can be imaged. A torn rotator cuff can be repaired. PTSD doesn’t show up on any scan, and state legislatures are increasingly asking whether that should matter.
In September, NCCI published its 2026 Legislative and Regulatory Trends Report, examining the issues occupying state legislatures and regulatory bodies across the country. As usual, there were as many commonalities as differences.
Several familiar subjects appear. Marijuana (cannabis) legalization and reimbursement continue to generate debate, as do psychedelics and their potential therapeutic applications. Worker classification and portable benefits are receiving increased attention as the gig economy challenges traditional employment relationships. Workers’ compensation alternatives and AI are also on the radar.
I’ve written about most of these subjects over the years. Their presence in this report did not surprise me. In my experience, most of what shows up in work comp starts somewhere else first. But one trend deserves particular attention as we approach 2027.
Mental injuries are becoming increasingly difficult for the workers’ compensation system to ignore.
Even chronic pain, for all its complexity, usually starts with a physical complaint we can identify. Psychological injuries often don’t. Post-traumatic stress disorder (PTSD), anxiety, depression, and other mental health conditions don’t necessarily produce the objective findings we’ve traditionally relied upon. Their causes can be complicated, their symptoms are unique per person, and their compensability can be difficult to establish. Yet the absence of a visible injury doesn’t make the suffering imaginary.
NCCI identifies mental injury legislation as a continuing trend, with most proposals still focused on first responders. In 2026, lawmakers concentrated on three questions:
- Who qualifies for coverage?
- Which conditions qualify?
- Which medical professionals can diagnose them?
Several states considered extending mental injury or PTSD coverage to additional workers, though mostly to roles adjacent to first response: coroners and death investigators in Idaho and Washington, emergency dispatchers in Vermont, correctional workers in Washington, and mine rescue teams in West Virginia. None of those bills advanced. Maryland, Minnesota, and New York considered expanding which practitioners can diagnose qualifying conditions. Minnesota’s bill became law, adding psychiatric mental health nurse practitioners, and New York’s passed both chambers. Collectively, they show legislatures reconsidering where the boundaries of compensability should be drawn.
However, trauma isn’t exclusive to those occupations.
Consider a retail employee assaulted during a robbery. A healthcare worker threatened by a patient. A teacher witnessing violence. An employee whose physical injury produces significant depression and anxiety during a prolonged recovery. I wrote about several of these scenarios in my October blog about our National Comp panel on workplace violence.
But expanding eligibility for mental injury benefits doesn’t automatically expand our ability to manage those claims effectively.
A claims professional accustomed to evaluating musculoskeletal injuries may suddenly need to understand psychiatric diagnoses, psychological testing, preexisting conditions, causation, treatment approaches, and the relationship between mental health and functional recovery.
Managing these claims also requires recognizing that mental injuries rarely exist in isolation. Biological, psychological, and social factors interact in ways that can either support recovery or complicate it. A diagnosis alone doesn’t tell us everything we need to know about someone’s ability to function.
It’s one reason I was one of the early voices for a biopsychosocial treatment model in work comp in 2010. The whole person affects the injured part. It wasn’t a popular position at the time. The pushback I heard most was, “We don’t want psych becoming a compensable diagnosis.” The good news is that the mind-body connection is more widely accepted today.
Legislation can change much faster than professional competence develops. That gap has real consequences for injured workers, employers, and the claims professionals trying to make defensible decisions.
It’s exactly why we built the Workers’ Compensation Mental Injury Claims Specialist (WCMICS) program at WorkCompCollege.com. Education won’t solve every problem. Whether your team learns this through us, another provider, or a seasoned colleague down the hall matters less than whether they learn it before these claims arrive.
It’s difficult to foresee which mental injury proposals will become law next year. Local politics, much of it behind the scenes, can send proposals down unpredictable paths. NCCI’s report, reflecting legislative activity through July 31, is a useful indicator of policy attention but not necessarily a forecast of becoming law. Still, its prominence in this report deserves our attention before New Year’s Day.
Speaking of which, the upcoming holidays usually bring a little downtime. Use some of it to ask a few honest questions about your team:
- Do our adjusters understand the differences among psychological injury categories?
- Can they evaluate a psychiatric diagnosis, causation, and preexisting conditions with confidence?
- Do our provider networks include appropriate mental health expertise?
- Do our return-to-work strategies account for psychological, not just physical, function?
During that process, resist two assumptions: that every psychological complaint is automatically work-related, and that an injury isn’t legitimate because we can’t see it. Neither serves the injured worker nor protects the integrity of the system.
Legislatures will decide which injuries we’re required to recognize. Whether we’re prepared to manage the ones we can’t see is up to us.
