The COVID-19 information you need for workers’ comp claims
The COVID-19 pandemic has most likely impacted you in some way, from the way you work, to how you live. And while this has been stressful for most of us, those who are also recovering from a work-related injury, or, like you, are helping them navigate care through recovery, face additional challenges and have additional questions.
So, with newsfeeds filled with projections and opinions, Optum has compiled the latest workers’ compensation focused COVID-19 information. Optum is working with our clients, our providers and injured persons to make sure they continue to receive the treatment they need when they need it.
This information will be updated frequently, so please bookmark this page so you are always one click away from the information you need.
The facts, the impact and the response to COVID-19 on the Workers’ Comp and Auto No-fault industry webinar
Hosted by David Young, President and CEO
Recent Covid-19 posts
September 03, 2020 · Public Policy & Regulatory Affairs Team
In the late hours of the legislative session, the California Assembly and Senate reached a compromise and passed a COVID-19 workers’ compensation presumption bill. After considering several various pieces of presumption legislation, the Legislature passed SB 1159, which creates a presumption and addresses the impact of COVID-19 on the workers’ compensation system. It is expected to be signed by the governor. Read more...
Montana and New York delay workers’ comp drug formularies for legacy claims and prescriptions due to COVID-19
April 09, 2020 · Policy Matters team
Montana requests insurers delay formulary implementation for legacy claims until COVID-19 crisis passes. And New York modifies formulary to extend implementation date for legacy scripts until January 1, 2021. Read more...
April 03, 2020 · Policy Matters team
Amid the coronavirus (COVID-19) outbreak, state governors, regulators and legislatures have initiated a range of urgent policy changes or directives to facilitate response and mitigation efforts, including at the workers’ compensation level. This heightened focus has diverted some attention away from other policy developments. Read more...
April 02, 2020 · From the desk of David W. Young
While there are many unknowns, Optum Workers’ Compensation and Auto No-Fault is committed to our customers, claimants and our team members. We remain fully staffed and operational and continue to ensure that the injured person is receiving the right treatment at the right time for the right duration and for the most appropriate cost. Read more...
covid-19 policy updates
COVID-19 presumptions for first responders and healthcare workers
If you or your claimants are experiencing anxiety or stress related to COVID-19, download the mobile app Sanvello, or call our free Emotional Support Help Line: 1-866-342-6892
External Covid-19 related resources
|Updated every Friday
*Additional presumption language for this state is provided below
Alaska - Senate Bill 241 (3.23.20)
Creates a conclusive presumption that COVID-19 arose out of employment for specified workers. The presumption, which can’t be rebutted, applies retroactively to anyone diagnosed with the disease since March 11. The presumption in SB 241 applies to firefighters, emergency medical technicians, paramedics, police officers and health care providers. Workers must be diagnosed by a physician, receive a presumptive positive test or receive a laboratory-confirmed diagnosis to trigger the presumption.
California – SB 1159 (9.17.20)
Creates a rebuttable presumption for first responders, healthcare workers and other essential employers running through 2022. The presumption is applicable to those deemed by existing statue as “essential employees” in both the public and private sectors. Requires a positive test or diagnosis within 14 days that the employee performed labor or services at the employee’s place of employment at the employer’s direction. Permits employers to rebut the presumption by measures which include, but are not limited to, evidence of measurers in place to prevent transmission of COVID-19 and evidence of the employee’s non-occupational exposure to COVID-19.
Illinois - House Bill 2455 (6.5.20)
Creates a COVID-19 related rebuttable presumption for first responders, healthcare providers and other essential employees. Contains substantial rebuttal provisions
Minnesota - HB 4537 (04.8.20)
An employee who contracts COVID-19 is presumed to have an occupational disease arising out of and in the course of employment if the employee satisfies the requirements of clauses (1) and (2).
(1) The employee was employed as a licensed peace officer under section 626.84, subdivision 1; firefighter; paramedic; nurse or health care worker, correctional officer, or security counselor employed by the state or a political subdivision at a corrections, detention, or secure treatment facility; emergency medical technician; a health care provider, nurse, or assistive employee employed in a health care, home care, or long-term care setting, with direct COVID-19 patient care or ancillary work in COVID-19 patient units; and workers required to provide child care to first responders and health care workers under Executive Order 20-02 and Executive Order 20-19.
(2) The employee's contraction of COVID-19 must be confirmed by a positive laboratory test or, if a laboratory test was not available for the employee, as diagnosed and documented by the employee's licensed physician, licensed physician's assistant, or licensed advanced practice registered nurse (APRN), based on the employee's symptoms. A copy of the positive laboratory test or the written documentation of the physician's, physician assistant's, or APRN's diagnosis shall be provided to the employer or insurer.
New Jersey – Senate Bill 2380 (9.14.20)
Creates a workers’ compensation presumption related to COVID-19 exposure. Covers first responders, health care for workers and others who have contact with the public. The rebuttable presumption covers COVID related claims retroactively from March 9, 2020 and stops when the governor’s declaration of a public health emergency comes to an end. The legislation bars insurers from counting COVID claims in an employers’ experience modification ratings and employees of the state who are offered the option of working from home but refuse will not be eligible for coverage and benefits.
Utah – HB 3007 (6.22.20)
Clarifies the definition of First Responder under the Act and adds certain healthcare workers to the definition related to the COVID-19 Presumption
Provides a Workers' compensation presumption for first responders.
(1) A first responder who claims to have contracted COVID-19 during the performance of the first responder's duties as a first responder, is presumed to have contracted COVID-19 during the course of performing the first responder's duties as a first responder if the first responder is diagnosed with COVID-19:
- while employed or serving as a first responder; or
- if the first responder's employment or service as a first responder terminates, within two weeks after the day on which the first responder's employment or service terminates.
(2) A first responder who makes a claim under this part shall provide written documentation of a COVID-19 diagnosis to the first responder's employer or insurer.
Failure to be tested – Rebuttable presumption.
(1) A first responder who refuses examination for COVID-19 or fails to be diagnosed with COVID-19 is not entitled to the presumption established under this part.
(2) The presumption established under this part may be rebutted by a preponderance of the evidence.
Vermont – Senate Bill 342 (7.16.20)
Provides a rebuttable presumption for a wide range of workers who fall ill from the coronavirus contracted it through work duties. The presumption is rebuttable by the employer. The bill applies to first responders, health workers, correctional officers and other essential workers and employees the state Workers’’ Compensation Commission determines are at an elevated risk of exposure. Those non-frontline workers will have to show occupational exposure, or employers can rebut the claim by showing that the business followed coronavirus guidelines published by Vermont health authorities and the U.S. Centers of Disease Control and Prevention. The presumption and requirements of the bill applies to virus claims on or after March 1, 2020.
Wisconsin - Assembly Bill 1038 (4.17.20)
Rebuttable presumption that injury caused to first responders during current public health emergency is caused by employment
For the purposes of worker's compensation, an injury caused to a first responder, during any public health emergency declared by the
governor on March 12, 2020, by executive order 72 and ending 30 days after the termination of the order, is presumed to be caused by the individual's employment.
The presumption requires a diagnosis or positive test for COVID-19, and may be rebutted by specific evidence that the injury was caused outside of employment.
Wyoming - SB 1002 (5.20.20)
For the period beginning January 1, 2020 through December 30, 2020, if any employee in an employment sector for which coverage is provided by this Act, is infected with the COVID-19 Coronavirus, it shall be presumed that the risk of contracting the illness or disease was increased by the nature of their employment.
|Emergency Declaration by Governor, DOI or WC Agency|
Arkansas – Executive Order – 6.15.20
For the purpose of exclusive rights and remedies under the Workers’ Compensation Law, Coronavirus disease 2019 (COVID-19) or a disease, health condition or threat caused by severe acute respiratory syndrome, or by any virus mutating from severe acute respiratory syndrome, shall be an exception to the prohibition in the Workers’ Compensation Law, addressing compensation for ordinary disease of life to which the general public is exposed. Any employee asserting an occupational disease under this Executive Order must meet all requirements of proof for an occupational disease, including a causal connection between employment and the disease. This Executive Order applies to all claims filed after the date of its execution and shall automatically expire when the emergency is terminated.
Connecticut - Executive Order (7.24.20)
- Creates a rebuttable presumption for employees who initiate a claim for payment and who missed a day or more of work between March 10, 2020 and May 20, 2020 due to a diagnosis of COVID-19 or due to symptoms that were diagnosed as COVID-19 as an occupational disease arising out of an in the course of employment for workers who are deemed essential by the Department of Economic and Community Development and who reported to work during those time periods.
- Employers can rebut the presumption by showing, with a preponderance of the evidence, that the workplace was not the source of the infection.
Kentucky - Executive Order (3.6.20)
Kentucky Gov. Andy Beshear executive order notes that health care workers, first responders, corrections officers, domestic violence shelter workers, child advocacy workers, rape crisis staff, grocery workers, some child care workers and even postal workers should receive wage-replacement benefits if kept away from work by a physician.
Michigan - Executive Order – 6.17.20
A presumption shall be created for any “COVID-19 response employee” who has direct prolonged contact with COVID-19 in the course of employment as well as a person required to report to the following workplaces:
- Ambulance operation, County medical care facility, EMT, Home for the aged, Hospice, Hospital, Nursing Home, Any person working to provide in-person medical care to patients, First responders and Law enforcement officers and others as listed.
Any of the listed persons confirmed as COVID-19 positive on or after March 18, 2020 – either by physician or test – shall be presumed to have suffered a ‘personal injury’ as defined by the Act. This emergency order replaces other emergency rules filed by the Secretary of State on March 30, 2020. This order shall not terminate until the end of the states of emergency and disaster declared in Executive Order 2020-99 or the end of any subsequent declarations.
Missouri - DL&I/DWC Emergency Rule (4.7.20)
Presumption of Occupational Disease for First Responders. An emergency rule under the workers’ compensation statute to provide a presumption that first responders contracting COVID-19 were infected in the course of their employment.
New Hampshire – Executive Order – (4.24.20)
“First Responder” shall include any individual covered by the definition of “Emergency response/public safety worker” as set forth under existing law.
To be eligible for this order and approved presumption a First Responder must have tested positive for COVID-19 and the case must have been reported to the Department of Health and Humans Services. In any subsequent proceeding before the New Hampshire Department of Labor or the administratively attached Compensation Appeals Board, there shall exist a prima facie presumption that the First Responders COVID-19 exposure and infection were occupationally related.
New Mexico (4.23.20)
As Governor, I hereby direct and order as follows:
- In processing or responding to WC claims, I direct all state executive agencies to employ a presumption that certain agency employees and eligible volunteers who contracted COVID-19 suffered a compensable occupational disease under existing law.
- The presumption should be applied to all agency employees and eligible volunteers who contract COVID-19 within two weeks of providing direct assistance or care to COVID-19 patients, or within two weeks of working in any capacity inside a facility that provides direct assistance, care or housing to COVID-19 patients.
- Some examples of employees who should be afforded this presumption include but are not limited to EMT’s and other first responders, volunteer and paid medical personnel, administrative and custodial staff at COVID-19 specific care centers and law enforcement officers.
North Dakota - Exec Order 2020-12 (3.13.20)
First Responders health care workers and all occupations included under NDCC 65-01-02 (11)(b)(1) who are exposed to COVID 19 in the course of employment may file for workers compensation coverage and may be eligible for up to fourteen days of wage replacement and medical coverage if quarantined.
Texas - TDWC Commissioner's Bulletin (3.27.20)
In order to ensure that public safety employees of governmental entities are able to be reimbursed by their employer for reasonable medical expenses related to COVID-19, Governor Abbott has suspended Texas Government Code Sections 607.002(1) and (2) to the extent necessary to allow public safety employees, who were likely to have been exposed to COVID-19 while in the course of their employment, to be entitled to the reimbursements set forth in Section 607.002 of the Government Code. This suspension is in effect until terminated by the Office of the Governor or until the March 13, 2020, disaster declaration is lifted or expires.
Sec. 607.002. REIMBURSEMENT. A public safety employee who is exposed to a contagious disease is entitled to reimbursement from the employing governmental entity for reasonable medical expenses incurred in treatment for the prevention of the disease if:
(1) the disease is not an "ordinary disease of life" as that term is used in the context of a workers' compensation claim;
(2) the exposure to the disease occurs during the course of the employment; and
(3) the employee requires preventative medical treatment because of exposure to the disease.
Washington - (3.5.20)
Pursuant to an order by Governor Jay Inslee, the WA DL&I is making policy changes around WC coverage for health care workers and first responders who are quarantined by a physician or public health officer. WC coverage will be extended for medical testing, treatment expenses if the worker becomes ill or injured and provide loss-time payments for those who cannot work if they are sick or quarantined. These benefits will cover workers during the time of quarantined after being exposed to COVID-19 on the job. Workers’ can file a WC claim up to two years after being exposed to a disease at work. The expanded coverage takes effect immediately.
|WC Agency Bulletin regarding existing exposure requirements|
All Regulated Entities are reminded that section 440.09, Florida Statutes, requires an employer to provide workers’ compensation coverage if the employee suffers a compensable injury arising out of work performed in the course and scope of employment. First responders, health care workers, and others that contract COVID-19 due to work-related exposure would be eligible for workers’ compensation benefits under Florida law. Insurers licensed to provide workers’ compensation coverage in Florida are reminded of this statutory requirement, which must be applied on a non-discriminatory basis. The OIR expects workers’ compensation insurers to comply with all of the provisions of Florida’s Workers’ Compensation Law and will take appropriate action in the event of non-compliance.
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