Health and Safety Leadership Alliance and IOH Mark September 11 With Five Recommendations for Complex First Responder Claims

Friday, September 11, 2026 | 128 | 0

SAN DIEGO, Calif. (September 11, 2026) On the 25th anniversary of September 11, Health & Safety Leadership Alliance and Institutes of Health (IOH) today issued five recommendations designed to reduce delays between a first responder's request for help and the start of coordinated treatment.

First responders are trained to take control of emergencies and keep functioning under pressure so they can protect others. Asking for help can run against both that training and the culture of public safety. By the time many finally come forward, their condition may already have become serious or disabling. They may be struggling with PTSD, severe anxiety, depression, chronic pain, sleep loss or cognitive problems that affect their ability to work and function day to day. At that point, some are in no condition to navigate a complicated claim or organize their own care.

Yet the workers' compensation process may effectively require them to do exactly that. Care can be delayed by separate evaluations, authorization requests and referrals. When treatment begins, one clinician may treat PTSD, another pain, and another sleep or cognitive problems, with no one responsible for seeing the whole case. At the moment coordinated care is most needed, the first responder may receive a collection of appointments without a recovery plan. The condition may worsen, disability may continue and the claim may become harder to resolve.

Twenty-five years after September 11, FDNY members continue to die from illnesses related to their work at the World Trade Center. On September 11, 2001, 343 members of the Fire Department of the City of New York (FDNY) were killed while responding to the attack. Earlier this month, the FDNY added 36 names to its World Trade Center Memorial Wall. Each was a member who died during the past year from an illness related to the rescue and recovery effort. Hundreds of FDNY members have now died from World Trade Center related illnesses.

First responders serving today face their own cumulative trauma, serious physical injuries and hazardous exposures, often while remaining on duty. Many still delay asking for help. When they finally come forward, delays and fragmented treatment can compound conditions that have already become serious.

"The injuries carried home from public safety work do not always show themselves right away," said retired Battalion Chief David Picone, CEO of the Health & Safety Leadership Alliance. Picone previously served as Health and Safety Battalion Chief for the City of San Diego Fire-Rescue Department. "A firefighter or police officer may keep working for months or years before asking for help. When that day comes, the next step should be clear. We should not send the member from office to office and expect that person to piece treatment together alone."

A complex first responder claim rarely fits neatly into one diagnosis. Post-traumatic stress disorder may occur with chronic pain, brain injury, disrupted sleep, depression, anxiety, cognitive problems or substance use. When treatment is authorized and delivered in separate pieces, the clinicians involved may never address how those conditions affect one another.

"Claims are often organized around separate diagnoses, but people do not experience injuries that way," said Dr. Tomer Anbar, Founder and CEO of Institutes of Health. "Pain affects sleep. Poor sleep affects concentration, mood and the ability to take part in treatment. If those problems are sent in different directions, the patient may have several appointments and still have no real recovery plan."

IOH refers to its coordinated approach as the Architecture of Care. The physicians, psychologists and rehabilitation professionals involved in a case work from one treatment plan and review the patient's progress together.

The five recommendations ask workers' compensation stakeholders to:

· Set a direct referral path from peer support and departmental wellness programs to a comprehensive clinical evaluation.

· Look for overlapping physical, psychological, cognitive and sleep-related conditions early in the claim.

· Select clinicians who understand public safety work, first responder culture and the demands involved in returning to duty.

· Organize authorized services under one plan so the clinicians can communicate and review progress together.

· Match the length and intensity of treatment to the complexity of the injury, with progress measured by function, safety and readiness to return to work as well as symptom improvement.

Most first responder claims will not require this level of care. The recommendations are intended for cases in which several conditions are interfering with function, participation in treatment or a safe return to work.

The U.S. Fire Administration recently noted that research indicates fire departments are more likely to experience a suicide than a line-of-duty death. The Alliance and IOH said employers and claims organizations need a clear process for responding when peer support or a departmental wellness program identifies a member who requires clinical care.

"September 11 asks us to remember who answered the call," Dr. Anbar said. "When a first responder comes forward, the workers' compensation system should be ready to answer as well. That means recognizing the full injury and avoiding unnecessary delay. To remember is to respond."

About Health and Safety Leadership Alliance

Health & Safety Leadership Alliance is a multi-stakeholder educational leadership platform serving workers' compensation, occupational health and public safety. It brings together public safety professionals, risk managers, claims professionals, clinicians, insurers, health systems and other stakeholders to advance evidence-based education, research and system improvement. More information is available at hslalliance.org.

About Institutes of Health

Institutes of Health is a California occupational health and rehabilitation organization specializing in complex trauma, chronic pain, brain injury, PTSD, sleep problems and substance use disorders. Its integrated clinical teams provide medical, psychological, neurocognitive, physical, occupational and related rehabilitation services focused on functional recovery and return to work. More information is available at institutesofhealth.org.

Source: Health & Safety Leadership Alliance and Institutes of Health