Workplace-related mental injuries, marijuana reimbursements, independent contractor classification, and single-payer health insurance were key areas of focus for state legislatures in 2024, according to the National Council on Compensation Insurance’s (NCCI) latest report.
The report, “2024 Regulatory and Legislative Trends,” highlights recent developments affecting the workers' compensation landscape.
The report tracks both federal and state-level legislative actions as of July 31, 2024, covering key topics such as mental injury-related compensation, marijuana legalization and its impact on workers' compensation, and issues affecting gig economy workers and independent contractors.
As of July 31, 2024, NCCI tracked 911 bills at the state and federal levels that could impact workers' compensation stakeholders, with 470 of those bills coming from states where NCCI provides ratemaking services. So far, 108 of those bills have been enacted.
Additionally, NCCI monitored 267 proposed workers' compensation regulations, of which 103 were adopted. The primary theme for adopted regulations this year was medical cost containment, particularly in areas such as fee schedules and treatment guidelines.
Mental injury-related workers' compensation legislation remained a significant focus in 2024, with NCCI tracking 64 bills on the topic. Fifty-two of these bills addressed compensability for workplace-related mental injuries, with 51 focusing on post-traumatic stress disorder (PTSD).
Three states – Alaska, Arizona, and Oklahoma – enacted legislation creating a presumption of compensability for PTSD in first responders. Alaska's SB 147 provides a presumption for certain first responders, while Arizona's SB 1677 and Oklahoma's SB 1457 also cover PTSD for certain categories of workers.
Several other states, including Florida, Iowa, Missouri, and Wisconsin, considered expanding coverage for mental injuries beyond first responders. New York's A 5745/S 6635, which seeks to extend coverage to all employees experiencing extraordinary work-related stress, remains pending.
In addition to mental injury-related presumptions, several states introduced legislation addressing presumptions for physical injuries or illnesses. These presumptions were primarily aimed at first responders and covered issues such as hearing loss, hypertension, and various types of cancer.
States such as Arizona, Maryland, Missouri, and Wyoming considered cancer-related presumption bills, with Maryland, West Virginia, and Wyoming enacting legislation in 2024.
NCCI continues to track legislative activity surrounding the legalization of certain hallucinogens and their potential impact on workers' compensation. Arizona's SB 1677 requires workers' compensation coverage for midomafetamine (MDMA) therapy for first responders with PTSD, pending FDA approval.
States such as Missouri, New Jersey, and New York have introduced bills to legalize psychedelics for medical or adult use, although most of these bills are not directly related to workers' compensation at this time.
Marijuana legalization also continues to be a prominent issue. While marijuana remains illegal at the federal level, several states, including Pennsylvania and Florida, are considering ballot measures or pending legislation to legalize recreational or medical marijuana.
Federal bill S 4226, introduced in May 2024, seeks to decriminalize marijuana by reclassifying it under the Controlled Substances Act.
State legislatures have also been debating whether to reimburse medical marijuana under workers' compensation. While most proposed bills exclude reimbursement for marijuana treatments, some states, such as Massachusetts and New Jersey, are considering legislation that would allow it under certain conditions.
The classification of gig workers and independent contractors remains an ongoing issue. California introduced AB 1928, which repeals the state's "ABC test" for determining whether a worker is classified as an employee or independent contractor. Other states, including New York, Pennsylvania, and West Virginia, have introduced legislation addressing worker classification criteria.
Gig economy workers, such as drivers for companies like Uber and Lyft, also continue to be the subject of legislative proposals. Washington enacted HB 2382, which extends survivor death benefits to dependents of transportation network company (TNC) drivers, while Massachusetts is considering several bills that would establish the employment status of app-based drivers.
The US Department of Labor also published a final rule effective March 2024, which provides criteria for determining worker status under the Fair Labor Standards Act. The rule relies on a multifactor "economic reality" test to assess whether a worker is classified as an employee or independent contractor.
Several states, including California, Maryland, New York, and Rhode Island, have introduced legislation to establish single-payer health insurance systems, with provisions that address workers' compensation coverage.
Although no state has fully implemented a single-payer system, ongoing studies continue to explore how such a system might integrate with existing workers' compensation structures.
At the federal level, two bills introduced in Congress – HR 3421 and S 1655 – propose a national Medicare for All system, which references workers' compensation.
Additionally, the State-Based Universal Health Care Act of 2023 (HR 6270) seeks to amend the Affordable Care Act to support state-based universal healthcare systems, although it does not specifically reference workers' compensation.
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