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March 31, 2020

Risk Management: Ways to Determine if Claims are Covered Under Workers’ Comp During COVID-19

photo of person with flu who might file a work comp claim

As the COVID-19 pandemic continues to spread, our clients are wondering if a claim for the coronavirus is covered under workers’ compensation (WC). While the answer depends on a number of factors, this article outlines some key considerations that may be used to determine coverage.

Regulatory Requirements

All states include occupational disease in workers’ compensation coverage, but each have their own jurisdictional requirements about what is considered an occupational illness or disease. For a disease such as COVID-19 to be covered, workers’ compensation statutes generally require that:

  • It arose out of and was in the course and scope of the employment
  • It is proven to be the result of workplace exposure
  • It is because employment placed the employee at a substantially greater risk of contracting the disease than experienced by the general public 

Claims Investigation

If your situation meets the above requirements and you file a claim, an investigation will be conducted. The claims examiner will want to know:

  • Are you paying the salary for voluntary quarantine of employees possibly exposed?
  • Do you have Foreign Voluntary Workers’ Compensation insurance coverage?
  • How, when and where contact with an infected person occurred. How many other employees may have been exposed
  • When did symptoms begin?
  • Has diagnosis of the coronavirus been confirmed?
  • Was personal protective equipment (PPE) provided? If so, is it required? What training is provided?
  • Did the employee or a member of their immediate family recently travel to an infected location? If so, when and why?
  • Did a work comp physician perform diagnostic tests for a definitive diagnosis?
  • Does the physician believe with a reasonable degree of medical certainty the condition arose out of and in the course of employment?

Claims Filing

Clients are also asking if they should file a workers’ compensation claim if an employee alleges an exposure at work, even knowing it most likely won’t be covered. In this case, yes, you should report a workers’ compensation claim without delay. Each case submitted will be reviewed independently according to the facts provided/discovered and any applicable state laws as described above. See our Best Practices for Workers' Compensation Claims article for additional details.

Final Thoughts on Work Comp and COVID-19

Workers’ Compensation may, or may not, come into play in relation to the impact of COVID-19 on employees. At this time, insurers indicate that contraction of the virus is not considered to be a work-related injury in most cases. Those business whose employees work is directly related to the coronavirus – first responders, health care workers, and testing labs, etc. – would likely be covered if an employee contracts the disease. As indicated above, it depends on state regulations, case law, WC Policy Terms, and how the virus was contracted.

If you have any questions, please contact a member of our team.

This is current as of March 31, 2020 but may have changed by the time you are reading this.

The information contained herein is not intended to be legal, accounting or other professional advice, nor are these comments directed to specific situations. The information contained herein is provided as general guidance and may be affected by changes in law or regulation. The information contained herein is not intended to replace or substitute for accounting or other professional advice. Attorneys or tax advisors must be consulted for assistance in specific situations. This information is provided as-is, with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein.

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