Chapter 148 of the Acts of 2018 shifted to the employer the burden of proving working conditions were not a significant contributing factor to the development of certain types of cancer in firefighters. The cancers in question commonly include leukemia, non-Hodgkin’s lymphoma, and brain, bladder and gastrointestinal cancers.

Chapter 148 amended Section 94B of Chapter 32 of the Massachusetts General Laws as well as Section 111F of Chapter 41. (For more about the state’s Cancer Presumption Law, visit

Cities and towns throughout Massachusetts are affected, as the new law impacts how they provide and pay for lost wages and medical benefits to firefighters and certain other public safety personnel, such as permanent members of a police department.

The law explained
The new law extends the presumption that cancer arose in the line of duty to firefighters who take leave for cancer diagnoses. The law mandates leave without loss of pay for the period of disability until the employee retires or is cleared of the condition by a physician.

Employees will need to pass a physical examination upon entry into service that shows there is no evidence of cancer. To be eligible for benefits, employees must serve in their positions for at least five years from the time that the medical condition is first discovered or should have been discovered.

Under the new law, an employee collecting benefits remains eligible for indemnification of medical expenses related to an illness that arises in the line of duty. Municipal employers may challenge a presumption by demonstrating that accidents or hazards not connected to employment caused the ailment.

MIIA’s health insurance provider, Blue Cross Blue Shield of Massachusetts, has weighed in on the presumption legislation with the following position:

“For firefighters, under state statute some medical conditions, such as types of cancer, are presumed to be related to employment for the purpose of determining entitlement to certain benefits. Because this is only a presumption, and Blue Cross Blue Shield of Massachusetts typically cannot determine with certainty that the medical condition at issue was the direct result of the member’s employment, Blue Cross Blue Shield of Massachusetts will generally pay these claims as the primary payer subject to the terms of the medical plan.”

New cancer presumption indemnity insurance
MIIA recommends that municipal employers review their existing coverage and consider adding cancer presumption indemnity insurance coverage to protect against paying for lost wages. Depending upon the type of coverage, it may provide weekly indemnity benefit options to complement current policy limits and lump sum benefits, depending upon the early or advanced stage of cancer and/or lifetime maximum benefits.

For example, MIIA’s new Cancer Presumption Indemnity coverage provides for weekly indemnity benefit options from $100 to $2,500 and lump sum benefits ranging from $6,250 to $50,000. (Note: It does not include medical benefits.)

Cancer prevention and training
Increasing awareness and strengthening prevention efforts can help to reduce occupational cancer risk. These efforts should include educating employees on safe work practices and proper safety equipment and clothing, as well as providing regular training programs and offering smoking cessation programs.

The National Volunteer Fire Council Cancer Subcommittee, along with other organizations, has developed a list of best practices for preventing firefighter cancer (visit These include measures such as wearing full protective equipment throughout incidents, cleaning exposed areas of the body while still on the scene, and extensive decontamination procedures. The Cancer Subcommittee also suggests having an annual physical, as early detection can improve outcomes.

Written by David Dowd Jr. and James Dunlap, Claims Directors for MIIA.