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COVID-19: workers compensation response - Helmsman

COVID-19: Workers Compensation Response

We’re here to help.

Coronavirus Disease 2019 (COVID-19) has quickly shifted from a story we were all following in the news to a very real threat facing employers, employees, and our families.

At Helmsman, two of our core values are put people first and act responsibly. It’s with these values in mind that we want to outline our approach for workers compensation (WC) claims management and share the employee safety strategies we are deploying.

WC coverage considerations and compensability

In general, an illness that arises from COVID-19 will need to meet both elements below to be compensable and result in WC benefit eligibility:

  1. Illness must arise out of the course and scope of employment.
  2. Illness must arise out of or be caused by conditions particular to the work and not an ordinary disease of life to which the general public is exposed.

In the case of COVID-19, it is critical to understand the unique job that an employee was performing if/when exposed. Many states have statutory language surrounding specific types of employment.

Helmsman is aware of the recent activity in many states involving Regulatory Advisory notices, Executive orders and/or legislative activity.  We are incorporating that guidance into both the review of the claim facts and the benefit decisions that follow on a claim by claim basis. 

For example, healthcare professionals, first responders (EMT), hospital workers, and lab technicians often have a lower threshold for connecting the cause/source to the course and scope of their work.

WC claim reporting and management

In accordance with state WC requirements, employees or managers who think they – or their colleagues – could have a COVID-19 work-related claim that meets the threshold for compensability, as outlined above, should report it immediately.

This will allow our team of workers compensation claims experts to work with you and your employee to determine if benefits are appropriately due.

Claims can be reported via our online portal or by calling 1-800-362-0000.

Our workers compensation claims experts are reviewing WC cases where COVID-19 is mentioned in the incident summary.

Claims specialists will work closely with our home office examining team and regional medical directors, as needed, to apply consistency and guide compensability investigations. Our team of experts has experience with other historical global infectious disease investigations.

As the infection spreads across the U.S., establishing place of work as the sole source of exposure, rather than exposure by the general public, will become increasingly challenging. Each claim will be considered as unique and with individual merits.

When you report a suspected COVID-19 related WC claim to us, please:

  • Mention COVID-19 in the accident description so we can immediately recognize the need to mobilize with our enhanced protocols.
  • Determine if the worker had contact with a person known to be infected with COVID-19. If so, include when and where that contact occurred.
  • Confirm when symptoms of COVID-19 began, and if the diagnosis has been confirmed.
  • Advise whether the worker, or any member of their immediate family, recently traveled to any high-risk areas.
  • Determine if immediate family members are currently showing similar symptoms.
  • Ask what other employees the worker may have had close contact with recently.
  • Share any information related to perceived higher risk of exposure for this specific employee and the nature of that exposure (e.g., healthcare worker or first responder).

If you do business in California, please visit California COVID-19 Employer Resources for more on the state’s special reporting and notice requirements.

Operational response plan for employers

The best way to contain exposure to COVID-19 during this period is to focus on employee well-being and safety. Here is some general guidance for businesses on how to prepare for and respond to COVID-19.

Helmsman’s business continuity

Our commitment to providing outstanding service is unwavering, especially in the face of uncertainty. Please continue to work with our teams as you always do. We have business continuity plans in place that will allow us to maintain our operations as this event unfolds.

Anticipated COVID-19 related workers compensation questions

How do I file a COVID-19 workers compensation claim?

In accordance with state WC requirements, employees or managers who think they or their colleagues could have a COVID-19 work-related claim should report it immediately.  This will allow our team of workers compensation claims experts to work with customers and injured workers to determine if benefits are appropriately due.

Our standard channels are able to handle COVID-19 claims. Customers can continue to report claims online through our online portals as normal, through EDI if applicable, or by calling 1-800-362-0000.

Will testing and quarantines be reimbursed under workers compensation?

Generally speaking, no. Precautionary measures do not fall within the parameters of WC compensability outlined above. An actual injury/illness must exist in order for us to begin an evaluation of workers compensation benefit determinations. We know this situation is fluid, and we will stay closely connected to any state or federal COVID-19 related amendments.  

Notwithstanding, please continue to submit all claims for appropriate review consistent with the policy and governing laws as each claim must be considered on its unique and individual merits.

It is recommended that you check on other available coverages including health or disability insurance and state-funded disability programs. Multiple states are taking actions by the day; for example, California’s Employee Development Dept has amended their disability benefits in response to COVID-19.

You should also review your group health plan for potential coverage for preventative care.

What happens to an existing claim if the worker cannot proceed with medical treatment due to the escalating COVID-19 situation?

We have asked our claims specialists to exercise judgement and flexibility on all claims. If delays need an additional review or clinical guidance, our nurses and doctors will step in to assist. Also, Liberty Mutual offers telehealth as an alternative to treat minor injuries, provide virtual physical therapy, and perform return to work readiness checks.

Does workers compensation typically cover employees traveling abroad?

Many State Acts extend coverage for foreign travel. Your WC policy may contain a Foreign Voluntary Compensation endorsement. That endorsement is subject to the same elements of compensability mentioned above. This endorsement typically addresses employees injured while outside the U.S., its territories, possessions, or Canada, and who are not subject to any state or federal WC, Occupational Disease Law, or any other similar law.  If your employee is in a country that lacks the infrastructure to provide proper medical care, repatriation expenses for transportation back to the United States or another country may be covered. 

What are some of the workers compensation excess endorsements?

There is an endorsement that may change how the aggregate deductible is applied. There may also be a crisis management endorsement which would help offset costs if necessary due to brand exposure.

For specific questions related to coverage, please work with your broker to understand the nature of your policy terms and conditions.

What guidance is there on extending disability payments due to an injured workers inability to attend a medical appointment?

Rescheduled or canceled appointments may prolong time off work or recovery times for injured workers. Our teams are working to mitigate this impact as much as possible. Regulations and practices on disability payments vary by state and jurisdiction, and the facts affecting each claim vary as well. The claims specialist is the best source for updates related to a specific claim.

What resources are available to customers to understand proposed regulatory changes and state actions?

In the face of the COVID-19 pandemic, regulators and legislators across the country are taking swift and frequent action to address emerging concerns within their regions. Helmsman is aware of the recent activity in many states involving Regulatory Advisory notices, Executive orders and/or legislative activity.  We are incorporating that guidance into both the review of the claim facts and the benefit decisions that follow on a claim by claim basis. 

We recognize that there is keen interest in understanding the jurisdictional actions influencing the industry landscape and are sharing, for informational purposes, resources of aggregated executive orders and proposed bills in state and federal jurisdictions.

NAIC Property and Casualty State Actions Guide

NCCI COVID-19 Regulatory and Legislative Activity

Resources

Visit our resources page for up-to-date information as the COVID-19 situation continues to evolve.

The illustrations, instructions, and principles contained in the material are general in scope and for marketing purposes. Our risk control services are advisory only. We assume no responsibility for: managing or controlling customer safety activities, implementing any recommended corrective measures, or identifying all potential hazards.