Less than one full month into 2026, and several states are off and running by pre-filing or introducing bills, which propose to add new or amend existing laws. As we continually track and monitor the ever-changing workers’ compensation legislative world, the MyMatrixx by Evernorth Regulatory Affairs team has outlined some of the newly introduced bills that, if passed and enacted, could have notable impact on workers’ compensation claims, coverage, and medical treatment in these states.
Presumptions
Just like 2025, special coverage for first responders through presumptions is a trend that is still sparking a lot of activity with several proposed laws seeking to provide coverage for conditions like cancer, cardiac health and mental stress. These presumptive coverage laws shift the burden of proof of a medical condition from the claimant/first responder to the employer when determining if a claim is compensable. The addition or expansion of these laws means greater access to care for first responders, but it also means increased workers’ compensation claims and higher costs for employers. Some examples of newly introduced bills we are tracking in this area:
· Arizona HB 2204 would amend the law to add post-traumatic stress disorder (PTSD) as a presumed compensable occupational disease if the first responder receives or has received licensed counseling and a licensed mental health professional diagnosed them with PTSD due to performance of service-related job duties.
· Illinois HB 4226 would add a hospital security guard to the existing law's presumption for a bloodborne pathogen, contagious staph infection, lung or respiratory disease or condition, heart or vascular disease or condition, hypertension, tuberculosis, or cancer. The existing presumption currently applies to firefighters, EMTs, and paramedics.
· Kentucky HB 26 would modify the definition of "injury" to include mental health conditions that are not direct results of physical injuries for specific categories of first responders. It establishes criteria for when those mental health conditions qualify as compensable work injuries and creates a rebuttable presumption for PTSD.
· Virginia HB 130 would extend the existing presumption for several cancers to include sheriffs and deputy sheriffs. That existing presumption applies to certain firefighters, state hazardous material officers, state troopers, arson or bomb investigators, sworn DMV enforcement division members, and members of the State Police Officers’ Retirement System who collect, analyze, or handle certain hazardous materials.
Provider choice
Choice of providers through provider networks and ‘direction of care’ can ensure stricter provider quality vetting and lower costs to payers but also raises concerns for injured worker choice. A few examples of bills in this area:
· Arizona HB 2813 would permit employers or insurers to establish “formal pharmacy management networks” to provide medications for injured workers under contracted rates and, most importantly, enforce their use.
· Indiana HB 1069 would amend the law to permit the injured worker to choose their attending physician, regardless of the date of injury. The existing law gives employers permission to choose the injured worker's attending physician.
· Washington HB 2218 and SB 5847 would add that an employer must inform the injured worker that they have a right to seek medical treatment with a provider of their own choice (reinforces existing law that grants this choice) and the employer is prohibited from requiring, or in any way inducing, a worker to seek medical treatment from a specific provider or clinic.
Medical treatment and coverage
Several notable bills have been proposed to amend state workers’ compensation laws in the broader area of medical treatment and coverage:
· Florida HB 527 would require human reviews of insurance claim denials (including in workers' comp) when algorithms, artificial intelligence systems, or machine learning systems are used in claims processing. The bill would also prohibit insurers from using automated systems as the sole basis for denying or reducing claim payments and require qualified human professionals to make final decisions.
· Missouri SB 1052 and SB 1385 would require the state’s Division of Workers' Compensation to establish a health care provider fee schedule for any service provided pursuant to the workers' comp law. Current law does not require a standard fee schedule but instead provides that all fees are to be fair and reasonable and not greater than the usual and customary fee for the same treatment or service when the payer is a private individual or health insurer. SB 1385 would also amend several other areas of the law beyond medical fees.
· New Hampshire HB 1352 would amend the state’s dispute resolution process, increase the provider payment timeline from 30 to 45 days, and increase the potential penalty amount for untimely payment.
· New Jersey SB 2757 would establish the statute of limitations for a medical fee dispute as two years from the date that a payment or notice of denial of payment was received by a claimant. The current statute of limitations, based on court interpretations, is six years.
Note: This is not legal advice, plan sponsors should consult their own counsel.
MyMatrixx is tracking it all
The MyMatrixx Regulatory Affairs team has added over 600 newly introduced bills to our tracking database since December 1, 2025, with many more to come. That is in addition to hundreds of still-pending bills carried over from last year.
Statistically, most bills introduced each year do not make it through the legislative process to become law, and accurately predicting their chances of becoming law early on is not always possible. However, several bills MyMatrixx is tracking this year will pass. Our team will engage with policymakers and clients where appropriate and advantageous to ensure good public policy for our industry.
For a broader view (and more details) of the legislation we are tracking across the country, visit the Legislative and Regulatory Policy Tracker on our Statehouse Watch webpage where you can sort bills (or regulations) by topic and state. Questions for our Regulatory Affairs team can be sent to MMXRegulatoryAffairs@MyMatrixx.com.