Coronavirus: Workers’ Compensation FAQs

Posted by Cathy Johnson In Business Insurance
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Does the Coronavirus create a workers’ compensation exposure?

The short answer is, not likely. Other than the fact that the Coronavirus is currently garnering intense attention, in most cases it is no more occupational than the flu.

Does Workers Compensation cover an employee who, while at work, comes into contact with a person who has the Coronavirus?

Generally speaking in a case where the employee does not actually contract the Coronavirus, it would not be covered by workers’ compensation because there needs to be an actual injury or disease to have workers’ compensation coverage. However, you should still file a claim just as you do now for shingles and TB exposure claims. Workers’ Compensation carriers have up to 14 days to pay or deny a claim that involves lost time, but even after that date, they could reverse a denial if the employee later develops the disease.

Does Workers Compensation cover an employee who, while at work, contracts the Coronavirus?

For an employee who contracts the disease, the employee would need to show an increased risk. The same standard would be applied to the Coronavirus as it would to the flu. Would this individual be at an increased risk beyond that of the general public to have contracted this disease? That being said, there may be coverage or there may not be coverage depending on the facts surrounding the claim. It all comes down to a case by case basis and the circumstances. Workers’ compensation carriers look at the facts of each specific case. Some cases may require additional investigation to accurately be identified as an ordinary disease of life or an occupational disease.

How does or might workers’ compensation respond to the Coronavirus?

Two tests must be satisfied before any illness or disease, including the Coronavirus, qualifies as occupational and thus compensable under workers’ compensation:

  • The illness or disease must be occupational, meaning that it arose out of and was in the course and scope of the employment; and
  • The illness or disease must arise out of or be caused by conditions peculiar to the work.

The simplest test toward determining whether an injury arises out of and in the course and scope of employment is to ask: Was the employee benefiting the employer when exposed to the illness or disease? Be warned, this test is subject to the interpretations and intricacies of various state laws.

Defining “peculiar” to the work?

An illness or disease is peculiar to the work when such a disease is found almost exclusively to workers in a certain field or there is an increased exposure to the illness or disease because of the employee’s working conditions. If the illness or disease is not peculiar to the work, it is not occupational and thus not compensable under workers’ compensation.
An example of an exposure peculiar to the work is a healthcare worker contracting an infectious disease such as HIV or hepatitis as a result of contact with infected blood. The worker’s unusual or peculiar exposure to such diseases results in an illness that is occupational and compensable.
Concluding that an illness is occupational, peculiar to the work and ultimately compensable is not necessarily based on the disease in question but on the facts surrounding the worker’s illness.

The Coronavirus Isn’t Special

Coronavirus may be a humankind exposure rather than one peculiar to most employments. Contracting the virus at work is not enough to trigger the assertion that it is a compensable occupational illness. To be occupational and compensable requires something peculiar about the work that increases the likelihood of getting sick. It is unlikely that both the occupational” and peculiar” thresholds can be satisfied to make most illnesses compensable” for the vast majority of individuals; the same is true of the new Coronavirus.

Factors investigated and considered by medical professionals and the court include:

  • The timing of the symptoms in relation to work: Do symptoms worsen at work and improve following prolonged absence from work (in the evening and on weekends);
  • Whether co-workers show or have experienced similar symptoms;
  • The commonality of such illness to workers in that particular industry;
  • An employee’s predisposition to the illness (an allergy or other medical issue); and
    The worker’s personal habits and medical history. Patients in poor medical condition (overweight, smokers, unrelated heart disease, etc.) and/or with poor family medical histories may be more likely to contract a disease or illness than others in similar circumstances. Bad habits and poor medical history (and heredity) cloud the relationship between the occupation and the illness. For example, smokers may be ill-equipped to fight off the effects of illnesses to which others may have no problem being exposed.

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