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Objective Rebuttable presumption legislation for work-related Post-Traumatic Stress Disorder (PTSD) designates work-relatedness for covered occupations in workers compensation. We compared outcomes of claims for PTSD in occupations covered and not covered by rebuttable presumption before and after a Minnesota law enacted in 2019.Materials and Methods Claims for PTSD in the workers’ compensation system were identified from nature of injury coding and key-word searches. The percentages of claims denied and claims receiving payments were calculated for the pre-law (2014-2018) and post-law (2019-2022) periods for presumption and non-presumption occupations. Payments were classified as regular claims or stipulations following appeal and legal proceedings. Log binomial regression models with an interaction variable for time period and presumption occupation tested differences in risk of the claim outcomes over time between presumption and non-presumption occupations adjusted for age, gender, job tenure, wage, and self-insured employer status.Results A total of 1,536 closed PTSD claims were identified. Initial claim denial rates increased from 91% in the pre-law period to 96% in the post-law period among presumption workers while decreasing among non-presumption workers (87% and 84%, respectively). The risk of receiving no payment for a denied PTSD claim from pre- to post-law among presumption workers was 49% lower compared to the change in risk among non-presumption workers (Relative Risk Ratio 0.51, 95% CI 0.39-0.67). In contrast, the increase in risk of receiving only stipulation payment from pre- to post-presumption law was two times greater among presumption workers than among non-presumption workers (RRR 2.00, 95% CI 1.40-2.86).Conclusion We observed limited effectiveness of a rebuttable presumption law in reducing initial denial rates for PTSD claims and subsequent litigation of denied claims. The root of this problem may be the structure of workers’ compensation systems not being compatible with a complex condition such as PTSD.