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

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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). Example of an occupational disease: Ship worker develops lung disease from exposure to asbestos may be occupational due to the type of work performed.

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. 

Common Questions and Responses:

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:

Content Disclaimer:  The information provided herein is for informational, educational and discussion purposes only and shall serve solely as a resource to be used together with your ABD professional insurance advisors in making risk management decisions.  While ABD endeavors to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability, or availability with respect to the information contained in this document.   The information provided herein does not constitute professional advice, nor does ABD provide professional advice beyond our current or prospective broker-client relationship. If you have legal, tax or financial planning questions, we advise you to contact a licensed professional.  If any actions or decisions are made based solely on the information provided herein without consultation with a licensed professional, you do so at your own risk and ABD shall have no liability resulting from such action or decisions.

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