There are a number of questions related to workers’ compensation and the current COVID-19 pandemic. Compounding the confusion is generally vague guidance stating that if workers are unable to do their usual job because they were exposed to and contracted COVID-19 during the regular course of their work, they may be eligible for workers’ compensation benefits.
Let’s clear up the confusion.
Generally speaking, from a workers’ compensation standpoint, the handling of illnesses/injuries related to COVID-19 is not significantly different from normal situations. If a worker sustains a work-related illness/injury, they MAY be eligible for workers’ compensation benefits IF the illness or injury is deemed to have occurred arising out of ANDduring the course of employment (AOE/COE).
Under ordinary circumstances, most viral illnesses are not usually covered under workers’ compensation because it is difficult to pinpoint when and where most workers were exposed to or contracted a virus. For example, who is to say the exposure did not occur elsewhere, such as at home or the grocery store?
There are exceptions in certain instances when a specific virus is traceable to a specific employment-related event, such as a healthcare worker who is exposed to patients who were diagnosed with the virus. In this instance, compensability would be difficult for an insurance adjuster or carrier to dispute.
In the case of COVID-19, most workers claiming their exposure occurred at work will face a challenge to substantiate the claim, which will be difficult to prove unless the worker has a documented case of being exposed to an infected person during the course and scope of their employment. As usual, any claim filed will need to be reviewed on a case-by-case basis to determine if there is any reasonable probability that the contraction of the illness occurred as a result of the claimant’s employment.
If your employee claims that they have sustained a work-related illness or injury, a claim should be referred to your insurance carrier, and the usual protocols for investigation of a reported illness/injury should be followed.
The COVID-19 pandemic is unprecedented. As the situation continues to develop, we will continue to monitor any changes that might affect the workers’ compensation landscape.
Western Growers Insurance Services is here to assist you. If you have any questions, please reach out to Ken Cooper at (949) 413-8751 or kcooper@wgis.com.