Is COVID-19 a Compensable Workers’ Compensation Disease?

COVID Work Comp ClaimThere is always a risk of an employee getting sick or injured at work, which is why state workers’ compensation insurance systems exist. The employer pays insurance premiums for a workers’ compensation insurance policy that provides employees coverage and benefits for any illness or injury arising out of and occurring in the course of their employment. However, COVID-19 is throwing employers and employees a curveball when it comes to what is and isn’t considered a compensable workers’ compensation claim as it relates to the pandemic.

What’s not covered and exceptions

Influenza and other infectious diseases are not typically covered or accepted under a workers’ compensation claim. In fact, many states specifically exclude disease from workers’ compensation policies. Therefore, an employee who is diagnosed with COVID-19 and unable to work would typically not have a compensable workers’ compensation claim.

However, there are exceptions that can be made for occupations in which the exposure is considered an occupational disease. For coverage to apply under this exception, employees must prove that the disease or illness was contracted within the capacity of their employment, either because they contracted it at the workplace or because it arose out of or was caused by conditions related to the employee’s scope of work. A good example would be a healthcare worker who contracts COVID-19, becomes ill and is unable to work.

The reason for this sticky area in workers’ compensation coverage is that COVID-19 is a highly contagious disease that can easily be spread outside the workplace. Because of this, and because there is typically a delay before symptoms begin, it can be difficult to determine just where the exposure originated. Therefore, the burden is on the employee to prove that the disease was indeed contracted within the scope of his or her employment and as a direct result of being on the job. Whether a claim is compensable will be based on the facts surrounding each individual case, evidence found during the claim investigation and the jurisdiction’s governing law. In some instances, it may even be decided by a court or the state’s workers’ compensation board.

Recent legislation changes in several states

Federal legislation has recently been enacted for disability and unemployment related to COVID-19, and each state applies its own jurisdictional statutes to occupational illness/disease. Individual states should be consulted for specifics as they consider what, when and how COVID-19 might be a compensable claim under workers’ compensation.

In March, Washington and Michigan issued specific directives on workers’ compensation coverage for the quarantine of healthcare workers and first responders. In April, the Illinois Workers’ Compensation Commission approved an emergency rule that guarantees that essential workers diagnosed with COVID-19 are automatically presumed to have contracted the illness at the workplace, even if they’re working remotely or are not currently on the job.

This month, California’s governor essentially flipped the switch and issued Executive Order N-62-20, creating a rebuttal that an employee’s COVID-19-related illness that arises out of the course of employment for workers’ compensation purposes is a compensable claim, but only if the employee tests positive or is diagnosed within 14 days after a day that the employee performed labor or services at his or her place of employment at the employer’s direction. The presumption does not apply if the employee was working from home. In addition, the date of illness must occur between March 19, 2020, and July 5, 2020. For employees who become ill, the Executive Order assumes that any test-confirmed COVID-19 illness is compensable under the employer’s workers’ compensation policy unless otherwise disputed.

This is a challenging time for everyone as we learn how to navigate changes brought about by the COVID-19 pandemic. At FastrackCE, we’re pleased that we can make it easy for you to maintain current CE licensing requirements so you can continue to serve your business clients. When you need us, we’re here to help. For more information, call 800-544-3605 or visit us at fastrackce.com.

Disclaimer: Every claim situation is different, and coverage under a workers’ compensation policy will be based on specific policy language and the facts and circumstances surrounding the evidence of the claim. Policyholders should always refer to the specific language of their insurance contract when determining if they have coverage for a loss.

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