UPDATES ON COVID-19
Determining where a person contracted Covid-19 is very challenging to prove but critical in terms of determining if a Covid-19 workers’ compensation claim will be accepted or denied. In order for a claim to be accepted, the claimant needs to demonstrate that there were no other potential known sources of exposure other than work. When the pandemic began last March, insurance carriers feared they would be inundated with workers’ comp claims. Fueling their concerns, more than a dozen states passed presumption of eligibility laws which gave employees in select, front line roles, access to workers’ comp coverage without having to prove that their infections occurred on the job. But despite the hundreds of thousands of Covid workers’ comp claims in 2020, the significant decline in non-Covid claims thanks to layoffs, remote work and shutdowns has more than offset these numbers. To date, the data suggestions that carriers are denying a significant number of virus-related claims, even in states with presumptive-eligibility laws. Accordingly to the National Council on Compensation Insurance, “In the first three quarters of 2020, workers’ compensation payments and liabilities were 7.6% lower than in the same period in 2019….partly because insurers received fewer than expected Covid-19-related claims for long hospitalizations and deaths.” At large, insurers remain cautious, concerned that long-haulers might tax the system with substantial and ongoing payouts for medical care and wage-replacement.
While national data on virus-related claims and payouts is not yet available, some data at the state level has been released. At present, more claims are being denied in states that don’t have presumptive-eligibility laws in place. Additionally, state and local employees’ claims were found to be accepted at a higher rate than private-sector employees. In TX, a state with no presumption of eligibility laws, 45% of the more than 32,000 Covid-19 claims, were denied which contrasts with CA which has presumption laws and saw 26% of the more than 93,400 claims filed, be declined.
Source: Weber, Lauren. “Why so many covid-19 workers’ comp claims are being rejected.” The Wallstreet Journal: February 14, 2021, https://www.wsj.com/articles/why-so-many-covid-19-workers-comp-claims-are-being-rejected-11613316304. Accessed: April 23, 2021.