TargetSolutions’ all-new course, NFPA 1851: Cancer-Related Risks of Firefighting, raises awareness of leading causes of cancer in the fire service and instructs personnel on firefighter cancer prevention measures.

Despite the inherent dangers that come with the job of fighting fires and saving lives from critical situations, cancer remains one of the leading causes of line-of-duty deaths in the fire service. This silent killer has been linked to specific carcinogenic agents and was proven to lurk in unexpected places, such as firefighters’ own personal protective equipment (PPE).

To help reduce the cancer risks of firefighting, TargetSolutions is proud to release an all-new course for the fire service: NFPA 1851 – Cancer-Related Risks of Firefighting.

“TargetSolutions recognizes just how serious of an issue this is for today’s fire service,” said Marc Scheipe, who serves as TargetSolutions’ executive vice president. “With that understanding comes a responsibility to create training courses that can make a difference. This course outlines the importance of care and cleaning for turnout gear, how to maintain and inspect PPE (personal protective equipment), and best practices for decontamination, isolation, and reporting of equipment-related issues. The course goes a long way to educate fire service members on how they can mitigate risk.”

Based on the 2014 NFPA standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, NFPA 1851 – Cancer-Related Risks of Firefighting delivers valuable lessons in firefighter cancer prevention. This two-hour course was authored by fire service instructor and subject matter expert, Paul Costello, who details current information regarding firefighter cancer risks and explains important measures in ensuring safety.

After completing TargetSolutions’ NFPA 1851 course, personnel will be able to achieve the following:

• Interpret important terminology as it relates to the NFPA 1851 Standard
• Explain how protective ensembles interfaces intersect with organs and the lymphatic system
• Explain how protective ensembles interfaces intersect with organs and the lymphatic system
• Recognize known carcinogenic agents and cancers associated with the fire service industry
• Employ best practices to reduce the risk of occupationally-related cancers
• Comprehend current legislation as it relates to fire-service-cancer diseases and diagnoses

These important topics are covered in 13, video-driven lessons and are guided by an in-course instructor. To ensure personnel can employ these best practices, frequent in-course quizzes and an end-of-course exam test for comprehension.

“Collectively, professionally, we’ve known that there was a correlation between firefighting and cancer for many years. This intrinsic knowledge that the profession has harbored is based on our own observations and losses to cancers at rates that seemed higher than those experienced outside of the fire service,” Costello said. “In the last few years, the data has become increasingly clearer, not only validating the correlation to firefighting, but in many instances the causation of several cancers as well.”

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Here’s a hypothetical story. A firefighter has been diagnosed with brain cancer. He has been in the fire service for over twenty years, and after receiving that terrible news, seeks workers’ compensation benefits to help cover the mounting costs of his medication, surgery, chemotherapy, and radiation.

What the firefighter and his family don’t realize is how long it can take for a decision to be made regarding whether his claim is accepted or denied. The investigation alone can delay the process for months as the firefighter is asked invasive questions about his family history, employment background, lifestyle, previous home addresses, and medical history. Even if an administrative law judge reaches a decision, the firefighter’s case could still end up going back and forth for years.

Unfortunately, there have been numerous real world cases in which firefighters have gone through this exhausting process only to be denied benefits. Even worse, there have been cases in which injured firefighters have passed away before a final decision was reached. Not only does this affect the firefighter, it also places the financial burden on the surviving family. This is the primary reason why the CFHC Trust created our Cancer Program.

The Trust strives to deliver payouts within 10 days of confirmation of a diagnosed cancer. That means the firefighter in our story would have received a cash payment based on the type and stage of his brain cancer, because it is one of the five covered cancers. There would have been no interrogation by insurance adjusters, no months and months of delay. He and his family could focus on what matters most—fighting his cancer and healing, so that he can get back to life and back to work.

Fire departments in Colorado now have the opportunity to provide their firefighters with stability and certainty in those difficult times. That alone can help improve morale and department cohesion. Right now, many workers’ compensation providers are giving fire departments financial incentive to join the Cancer Program. These include Pinnacol Assurance and the Colorado Special Districts Pool. For more information on their programs contact your workers’ compensation provider.

If you’d like to chat with us about getting started with the Cancer Program, click here to request a quote or feel free to contact us.

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How do you know when the Workers’ Compensation firefighters’ presumption is broken?

• Journalists discuss individual WC cancer cases on TV, in print, and online
• It takes more than a year—or even two years—before a decision is made whether to accept or deny a claim
• Firefighters pass away before being awarded benefits
• Cancer cases go before the state Supreme Court

On May 3, 2017, Colorado Governor John Hickenlooper signed into law an opportunity for fire operations to voluntarily opt in to an accident-type policy, which is triggered upon a diagnosis of one of the five statutorily-covered cancers, thus getting out of the state’s rebuttable workers’ compensation presumption of cancer for firefighters.

In May 2007, Colorado passed a bill that placed a rebuttable workers’ compensation presumption on five cancers. Under this law, the burden of proof moved from the firefighter having to prove the cancer was job-related to the employer now having to prove, with a preponderance of evidence, that the cancer was not job-related.

Prior to the passage of the presumption law, a plaintiff employee would have spent months preparing their case by gathering evidence. After the law was passed, employers would have to spend a similar amount of time and effort to conduct an investigation of their own. This involved an invasive, time-consuming inquiry into exposures such as:

• Conditions in the claimant’s current and previous places of residence
• Environmental conditions at the claimant’s current and past places of residence
• Hobbies
• Genetics and family history
• Lifestyle (smoking, dietary preferences, etc.)
• Prior medical history

This scrutiny can be considered intrusive, but is necessary to make a reasonable determination whether the claimant has been exposed to known carcinogens linked to the five types of cancers covered in the statute outside of the workplace.

In Colorado, the workers’ compensation statute says the claims adjuster has only twenty days to determine the compensability of a claim or they must file a Tentative Notice of Contest (TNOC), subject to further investigation. An investigation like this simply cannot be completed in 20 days due to the amount of records that need to be obtained and thoroughly reviewed; therefore a TNOC is automatically sent when these claims are received. Many employees react to these notices with both shock and confusion, assuming the letter represents a flat denial. They respond by immediately seeking legal representation.

Now, here we are nine years later with many cases involving an attorney and taking six months to several years for investigation, and a high percentage going to court. There were three cases that finally settled after two years at the state Supreme Court. The rulings were widely seen to be in favor of an employer’s right to rebut the presumption with evidence that the cancer was not job-related. Everyone agreed that there had to be a better way to resolve this difficult issue. Handling the majority of an estimated 180 cancer claims over a nine year period in a hearing room has not worked for anyone.

In 2011, as WC rates and loss experience continued to compound and cause premiums to soar, a collaborative effort had already begun with the Colorado State Fire Chiefs (CSFC) and the Colorado Professional Fire Fighters (CPFF) agreeing to open a dialogue. In their conversations, they began to look for other ways to cover disease than through workers’ compensation. In 2013 firefighters were looking at a new presumption bill for heart attacks to be introduced in the 2014 legislation. The CPFF already had their legislation drafted but were willing to talk to the CSFC.

In early 2013, a group of stakeholders asked the administrator of the Colorado Special Districts WC public entity pool, to facilitate. We sat down and started with what the stakeholders did not like about the way things worked in general, and then moved to address these issues with solutions. By focusing on avoiding the problems with the cancer presumption, we found an easy-to-administer accident-type policy format that served everyone’s needs. CPFF felt at the end of the process that if this worked they would consider amending the 2008 WC presumption of cancer statute in favor of an accident-type program. This then became the motivation for the Chiefs and the workers’ compensation pools to make the program work.

In an interesting twist with the heart program, when this proposed mandatory legislation was introduced with both the union and the management association in lock step at the capital, the City Municipal League objected on the grounds that this was an unfunded mandate. In response, the CPFF sought assistance from the State who determined that solving cardiac issues for firefighters was deemed an important safety issue and earmarked $900,000 to reimburse fire operations that met the coverage criteria within the legislation.

For the cardiac program, we started with an insurance industry off-the-shelf solution appropriately priced, but found that underwriters got cold feet. Every accident market approached was skeptical of their ability to deliver our custom product in the time needed. This meant we had to be creative and restructure Multiple Employer Trust laws to accommodate a facility. We built our own program which kept the funds in Colorado, a concern of the governor, and was owned and managed by the members. This solution produced twice the benefit at a reduced cost. Three years later, the program covers one- third of Colorado firefighters. It has paid 90 percent of the 21 submitted claims within 10 days of completed claim form. Rejected claims simply did not meet eligibility requirements.

With the cardiac program working so well, all involved parties became confident that this model could work to solve the presumption issue for cancer as well. Since no funding was available we had to analyze how this accident coverage might work on a voluntary basis where fire operations could obtain coverage under an accident policy and not be liable under the earlier presumption statute. This meant that if a department ever left the program, they would fall back under the 2007 presumption law. Additionally, any firefighter working for a participating department can still file a workers’ compensation claim for cancer but they would have to do it under the 2006 pre-presumption workers’ compensation statute where the burden of proof falls on the employee. We structured it so any benefit received in that scenario would be offset by benefits received under the accident program.

Both of these programs work because our only goal is to address the issues with the presumption rule and apply solutions from other programs that work well. We do not provide health care, retirement, disability, death or spouse/dependent coverage. We simply award a cash benefit based on a diagnosis and an indication of severity to reimburse the anticipated out-of-pocket expenses. Cash awards are paid out over a period of time with limited conditions or offsets. The firefighter is encouraged financially to return to work. The awards are intended to reimburse the firefighter up front for the value of benefits given up under WC and are, for the most part, not taxable.

• Elimination of unlimited liability of a firefighter to come back to the department to file a cancer claim once they leave employment
• No extended period of investigation leaving firefighter without a source of income or question on who is paying the medical bills
• Payouts capped at $250,000 at highest level
• Self-insured entities eligible for lower self-insured retentions and 15% to 20% reduced rates
• Firefighters are incentivized to return to duty
• Significant percentage of litigation cost savings
• Elimination of perceived wedge issue between management and labor

• No invasive investigation
• Payment based on type and stage of cancer
• Payments start within 10 days of completed claim form
• Twice as many claims accepted funding same cancer cost as in prior 10 years
• No offsets other an if a WC claim is filed under 2006 statute
• Line of duty status as a condition of this program
• No longer have to sue employer for equitable payment
• Payments with consideration gained from reduced litigation cost
• Not taxable, except for rehabilitation payments

The newly created Cancer program was launched on July 1, 2017. 2000 firefighters through 45 departments were founding members. Roughly 25% of the eligible paid firefighters and 10% of the eligible volunteers have signed up for the new program at the date of the writing of this article. The Board of Directors for the public entity pool we administrate has reimbursed the cost of this coverage in full while another WC Pool is considering its options. Commercial carriers have also outlined considerable discounts for their participating members effective January 1, 2018.

Recent pro-employer rulings in the state Supreme Court may embolden some fire departments to stay the course with the existing statutory model, but that flies in the face of potential public outcry over not doing the right thing for their firefighters. First responders are held in the highest esteem by everyone, from children to the elderly. We feel that is motivation enough. Garry Briese, Executive Director for the Colorado State Fire Chiefs Association, calls this program a “historic first-in-the-nation.” Management and labor came together to collaborate on an issue that was intended to benefit firefighters that was fraught with problems. We are all excited to see what successes lay ahead.

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Discussion of provisions SB17-214 subsection 13 regarding treatment as on the job illness or injury

There is definitely confusion surrounding this issue so we will clarify our understanding. The issue seems to come up when the phrase “ON-THE-JOB INJURY OR ILLNESS” is taken only in reference to one sentence and outside the context of the whole legislation.

In its entirety Section 13 specifically states that “This Subsection (13) does not affect any determination as to whether the cancer is covered under the “Workers’ Compensation Act of Colorado Articles 40 to 47 of Title 8.” This, in and of itself, should be enough clarity. The complete wording is:

(13) FOR THE PURPOSE OF EMPLOYER POLICIES AND BENEFITS, A CANCER DIAGNOSIS IS TREATED AS AN ON-THE-JOB INJURY OR ILLNESS. THIS SUBSECTION (13) DOES NOT AFFECT ANY DETERMINATION AS TO WHETHER THE CANCER IS COVERED UNDER THE “WORKERS’ COMPENSATION ACT OF COLORADO”, ARTICLES 40 TO 47 OF TITLE 8.

The Colorado Division of Workers’ Compensation added the above highlighted wording specifically to protect this employer designation of “treated as an on-the-job” from being interpreted as work-related for the purposes of workers’ compensation. This is simply a “condition of payment” agreed to by the employer for the sake of argument as reflected in the title of this subsection. The only purpose of the phrase “ON-THE-JOB INJURY OR ILLNESS” in the statute is to ensure that firefighters do not lose the Line of Duty benefit from their employers that are currently held. This Line of Duty benefit is a short term disability treatment typically associated with such an incident, and it varies from one department to another and ranges from nothing to one year’s salary. This subsection does not change Colorado workers’ compensation statute unlike Section 2 below.

As stated, this portion of the legislation does take cancer for firefighters out of WC:

SECTION 2. In Colorado Revised Statutes, 8-41-209, add (4) as follows: 8-41-209. Coverage for occupational diseases contracted by firefighters. (4) AN EMPLOYER WHO PARTICIPATES IN THE VOLUNTARY FIREFIGHTER CANCER BENEFITS PROGRAM CREATED IN PART 4 OF ARTICLE 5 OF TITLE 29 IS NOT SUBJECT TO THIS SECTION UNLESS THE EMPLOYER ENDS PARTICIPATION IN THAT PROGRAM.

By joining the Trust, fire operations no longer have any liability under the 2007 presumption law. To reemphasize, cancer classified as an “ON-THE-JOB INJURY” in Subsection 13 has no bearing given cancer’s exclusion from WC by law. Disease, as a general rule, is not covered by WC except where it can be proven to be work related. If cancer were not excluded from WC, health carriers would have to cover it the same way they did in 2006, and be subject to bad faith claims as they have no basis for denial. The new legislation was built on the premise that employers agreed to certain concessions in exchange for firefighters giving up their rights under the 2007 WC presumption statute:

• There would be no investigation to determine the cause of the cancer because neither the employer nor the firefighter is conducting an investigation.
• Employers agree to treat cancer as “in the line of duty,” even though it is debatable. This “Condition of Payment” as stated in the statute is part of the agreement, and does not change the previous WC statute nor does it constitute the burden of proof required under that statute.

A review of one health benefits carrier’s policy exclusions states:

Workers’ Compensation of Employer’s Liability. Financial responsibility for Services for any illness, injury, or condition, to the extent a payment or any other benefits, including any amount received as a settlement (collectively referred to as “Financial Benefits”) is provided under any workers’ compensation or employer’s liability law. We will provide Services even if it is unclear whether you are entitled to a Financial Benefit, but we may recover Charges for any such Services from the following sources

1. Any source providing a Financial Benefit or from whom a Financial Benefit is due.
2. You, to the extent that a Financial Benefit is provided or payable or would have been required if you had diligently sought to establish your rights to a Financial Benefit under any workers’ compensation or employer’s liability law.

Under the new legislation, firefighters are spared an invasive inquiry into their personal medical, family, and lifestyle histories to determine the source of the disease. Additionally, firefighters need to be aware that this is not workers’ compensation, but rather coverage that pays out-of-pocket expenses due to a covered cancer diagnosis.

We hope you find this discussion helpful. Please let me know where further clarification can be made. We would like to have this discussion distributed to all interested parties as we understand several of the self-insured share the same concerns.

For a printable version of this discussion, click here.

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