Whether workers' compensation claims related to COVID-19 will be paid is a question to be answered case by case and state by state.
The world has seen numerous epidemics whose impact on public health is well documented, so you might expect to find guidance on compensability from these experiences. But according to the National Council on Compensation Insurance (NCCI), “You would be hard-pressed to find meaningful information on how or even if the workers' compensation system was affected” by the SARS, H1N1, Ebola, and Zika outbreaks.
Workers' comp insurance typically covers employers for employee claims regarding “bodily injury by accident or bodily injury by disease.” Many state statutes, however, exclude “ordinary disease of life.”
While some occupations – for example, health care workers and first responders – might be said to have a higher probability than others for exposure to COVID-19, whether the disease is compensable under workers' comp is uncertain.
“’Would time away from work during recovery be considered ‘temporary disability’,”’ NCCI asks, “or is it just normal ‘sick time’?”
Guaranteed benefits for some
Workers’ comp insurers in at least two states have said they will guarantee benefits for health workers and first responders.
Kentucky Employers Mutual Insurance Co. said it will pay wage-replacement benefits for any first responder or employee in the medical field who is quarantined because of direct exposure to a person diagnosed with COVID-19. The announcement follows a decision by the Washington State Department of Labor and Industries to pay wage-loss and medical treatment expenses for any health care worker or first responder who is quarantined because of coronavirus exposure. Washington operates a monopoly workers' comp system, so that policy affects every employee covered by the state system.
It remains to be seen if other states will take the same measures relative to workers comp. For general health insurance, however, NCCI says at least 10 states have issued mandates to cover COVID-19. The mandates vary, but they include coverage for testing and visits to emergency rooms or urgent care facilities either in-network or out-of-network without deductibles or copays.
If expanded to more states, NCCI says, these mandates could limit workers' comp claims in cases where only testing or quarantine are necessary.
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