Workers’ compensation isn’t just about injury treatment and pain management. For the past few years, there has been an influx of presumptive coverage legislation related to expanding workers’ comp coverage for chronic conditions. In 2025 alone, 90 presumption bills have been introduced, most of which are proposing additional coverage to include new conditions and occupations.
Making care more accessible for these conditions is an important step in improving patient outcomes, but if these complex claims aren’t properly managed, it can lead to significant cost increases for employers and insurers.
In a recent WorkCompWire Leaders Speak, Alan Rook, Senior Clinical Account Executive for MyMatrixx by Evernorth, explains the MyMatrixx approach to managing these conditions and how we are providing treatment that is comprehensive, safe and effective for the patient, while helping to control costs for the payer.
What chronic conditions qualify for presumptive coverage in workers’ comp?
Presumption criteria varies by state, and new laws will continue to be introduced and affect the eligibility of different chronic conditions. That being said, some of the most common chronic conditions we see included in presumptive workers’ comp coverage include:
- Certain types of cancer
- Hypertension and other cardiovascular conditions
- Respiratory conditions, including asthma and COPD
- Long COVID
- Mental health conditions, primarily PTSD
- Comorbid conditions, such as diabetes and obesity
You might consider many of these conditions to be common because most of us know someone who has or has had one of them. Yet, from a caregiver and pharmacy perspective, these conditions, their severity, and their impact are intrinsically unique to a patient. From a payer perspective, these conditions can be complex, costly and chronic. From a patient perspective, they are looking for answers and outcomes.
How MyMatrixx is empowering patients while protecting payers
To effectively manage presumptive conditions, pharmacy solutions providers have to go beyond the transactional steps of treating an injury and focus on holistic, whole-patient care.
Click the link below to read the full article in WorkCompWire and learn about MyMatrixx’s whole-patient approach to disease management in workers’ compensation.