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Workers' Comp Claims & COVID-19

March 23, 2020

What to do if an employee is diagnosed with COVID-19

If an employee is diagnosed with COVID-19 and indicates to a member of management that they believe their sickness arose out of their work environment, report the claim to Synergy immediately. Have the employee follow the doctor's orders regarding isolation and treatment. According to the CDC, "inform fellow employees of their possible exposure but maintain confidentiality as required by the ADA. These employees should then self monitor for symptoms."

Synergy's Adjusters will thoroughly investigate every claim received and will keep you, the employer, involved every step of the way.

Most state statutes across the US are very similar regarding conditions that do not arise from an accident. While each state has its own nuances, the employee is generally required to prove the following before a claim can be deemed compensable:

  1. The condition arose from an inherent risk of the employment; AND
  2. The contraction of the condition occurred at work.

Both of these requirements would be very hard to prove due to the fact that COVID-19 is a fast moving communicable disease and there is a 2-14 day incubation period; therefore, it is difficult to determine the origin of infection. This means it is highly unlikely that a claim for COVID-19 is a compensable workers' compensation claim.

Below are a few situations that come to mind where compensability could be possible although improbable.

  1. Certain health care workers and first responders: It could be argued that their employment puts them at a greater risk than the general public.
  2. Certain airline employees for the same reason stated above.
  3. Employees who are required to travel. This scenario could sway the courts into believing that the employer put an employee at a heightened risk. Therefore, in an abundance of caution, Synergy strongly suggests eliminating travel requirements for the time being.

What about claims that are already in place?

Synergy is fully operational and running without interruption. Receiving timely health care treatment for non-emergency situations, however, is starting to become difficult in certain areas (we've been notified that some IMEs and follow-up appointments have been canceled). We will continue to pursue timely medical treatment but realize there may be a longer wait time.

Additionally, most state workers' compensation commissions have discontinued non-emergency proceedings. However, there are still ways to mediate claims virtually and file various motions electronically. Synergy is still pushing claims along despite this obstacle.

Rest assured that Synergy continues to operate efficiently in this environment. If you have any questions, please reach out to your Synergy contact. We know that things are changing quickly and it is unsettling times. We are here to help.