COVID-19 and workers’ comp: Compensability and other trends

SFM has been seeing workers’ compensation claims for COVID-19 since the pandemic began. Here’s a look at how we’re handling those claims, and some of the unique issues they present.

When is COVID-19 a compensable work injury?

State laws have a significant impact on whether workers’ compensation claims for COVID-19 are compensable, and among SFM’s core states the laws range widely in their expansiveness.

In Minnesota if first responders, health care workers or the workers who care for their children get COVID-19, it’s presumed work-related under a statutory change effective through May 1, 2021, unless we can rebut the presumption by showing that work exposure was not possible or that the employee clearly contracted COVID-19 elsewhere. All other workers are covered by the state’s occupational disease statute (minus the presumption) which allows compensability when a worker can show a proximate cause between their job duties and the COVID infection.

Iowa does not have a presumption, but its occupational disease statute is more expansive than many states, allowing for compensability when the character of the business and occupation puts the employee at increased risk, and the employee can establish a direct causal relationship between the job and becoming infected. An example would be a nurse working on a COVID-19 floor in a hospital.

(See COVID-19 presumptions by state.)

In contrast, Nebraska has a very limited occupational disease statute which excludes “all ordinary diseases of life to which the general public is exposed.”

In Minnesota as of September 11 there had been 4,822 COVID-19 claims reported. The largest group of reported claims have been in health care and nursing care facilities, followed by animal processing. Most of the claims covered under the presumption are accepted, whereas claims in occupations not covered under the presumption, such as meat processing, have been largely denied.

The Minnesota Department of Labor and Industry regularly provides updated statistics on its website .

Trends and issues of COVID-19 claims

On average, COVID-19 workers’ compensation claims cost less than other lost-time claims. Most employees are off work for two weeks and have relatively few medical costs.

As you might expect with an infectious disease, we do tend to see COVID-19 claims reported in clusters.

There are a couple of other unique issues we’ve seen with these claims:

  • Health care employees who work in multiple facilities
    In these cases, we try to determine where the employee was exposed to the virus. If this cannot be determined, then the cost of the claim can be split between the employers, if the employers and insurers agree.
  • Employees who test positive a second time
    The question becomes whether this is a new infection, or a re-emergence of the original infection. The answer is not clear and the scientific understanding of reinfection is developing.  In many ways, this may be an issue with little impact to employers' workers’ compensation premiums because the different ratemaking agencies have decided not to count COVID-19 claims toward an employer’s experience modification factor.

In workers’ compensation, as in all areas touched by COVID-19, the situation is continually evolving and much remains unknown.

SFM’s claims, medical and legal experts continue to monitor developments related to COVID-19 claims. Visit our COVID-19 resources page for information you can provide to the policyholders you work with.

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