Workers' Compensation: Best Practice Responses During COVID-19 Pandemic

Workers’ compensation provides benefits to employees for occupational injuries, illnesses and diseases that arise out of and in the course of employment, Arising Out of Employment / Course of Employment (AOE/COE).

In the face of the coronavirus (COVID-19), employers’ primary focus is the health and welfare of employees and family. So, you may be wondering “is COVID-19 considered an occupational disease, if exposed at work? If so, what are the best practices with handling potential exposure?”

Generally, COVID-19 should be treated like any other viral disease, which is typically not work related.  However, if an employee has an increased risk of contracting the virus due to the ‘peculiarity’ of their job (such as emergency medical technicians, health care workers, or first responders) with increased exposure to the virus due to their working conditions, the illness sustained as a result of confirmed exposure may trigger workers’ compensation benefits.

If an employee indicates they feel they may have been exposed at work, using your already established reporting process, immediately file a claim with your workers’ compensation carrier or third-party administrator.  You should also immediately conduct an internal investigation documenting when and where the employee could have been exposed. Follow your jurisdiction’s guidelines regarding appropriate employee notices. Based on preliminary investigation, employee’s duties and risk exposure, the carrier/ third-party administrator (TPA) can either accept, deny or delay for further investigation, the claim. Ultimately, the carrier/TPA would make the final determination on compensability.

What should an employer do if an employee states they were exposed at work:

Advise the employee to self-isolate and determine whether medical care is needed.

Once the employee is isolated, set up a time to gather all relevant details related to the incident such as: when, where, and how they may have been exposed, any contacts with other employees, and report the claim as soon as possible to your workers’ compensation carrier/TPA.

How do I report a Workers’ compensation claim for a suspected COVID-19 exposure?

The process to report a workers’ compensation claim currently remains the same. You can call your workers’ compensation carriers / Third-Party claim administrators 24-hour phone number or report online, if available.

How will the workers’ compensation carrier/TPA determine whether to accept or deny a claim for Workers’ Compensation benefits due to alleged exposure to COVID-19?

Typically, the workers’ compensation carrier/TPA will conduct a thorough investigation, which would include review of any medical reports to determine if the disease meets compensability requirements – (AOE/COE). However, given that COVID-19 is emerging and constantly changing, carriers may need some additional time to assess the details of the incidents specific to the employee’s condition before making a compensability decision.

Possible exceptions are occupations with ‘increased risk’ exposures – healthcare workers and first responders.

Reference sites for additional information:

• National Council on Compensation Insurance – COVID-19 and Workers Compensation
• State of California Department of Industrial Relations – Coronavirus Disease (COVID-19) – FAQs on laws enforced by the California Labor Commissioner’s Office
• State of CA Employment Development Department – Coronavirus 2019
• US Chamber of Commerce