March 21, 2022 Workers’ Comp and COVID Coverage

If you’re an employer, the question as to whether your workers’ comp policy covers COVID-19 for your employees depends on the state.

By Craig Shapiro, Vice President, Product & Underwriting for Cerity

COVID-19 has been the leading cause of change for how we live today. From social distancing to wearing masks and increased telecommuting, we have taken every precaution to slow the spread of the virus. However, despite our efforts, there is always a chance of contracting the virus — especially for first responders, healthcare workers, and employees who work in industries that cannot be adapted for working from home. This holds true even as cases subside.

The pandemic has presented businesses and employees with many unique problems, one of which is workers’ comp coverage for COVID. The answer to whether COVID is covered by your workers’ comp policy is complicated. It depends on a variety of circumstances including your state’s laws, the details of your workers’ comp policy, and how/when the claim is filed.

Workers’ Comp and Illnesses

Although it varies from state to state, most workers’ compensation policies do not typically cover community-spread illness. For example, common colds or the flu are community-spread illnesses that can be easily transmitted, making it hard to determine if an employee contracted them in the workplace. And as we know with workers’ comp, proving a direct link between the illness or injury and the employee’s scope of work is essential to getting a claim approved. 

In some states, workers’ compensation policies usually do cover chronic illnesses, like cancer or respiratory disease, that are linked to the workplace tasks or environment. These most frequently occur in jobs that regularly expose employees to toxic materials or environments. 

COVID-19 is a unique situation, because employees can contract the virus while working in jobs that previously were not considered to be hazardous environments. Healthcare workers and other employees at essential businesses are now at risk of contracting the virus due to high exposure to people, limited opportunities for social distancing, and other working conditions that now can be dangerous. 

States’ Approach to Workers’ Comp & COVID-19

Some states have amended workers’ comp laws to include presumption of occupational disease for certain types of employees, including healthcare workers, first responders, essential workers, those who work in close proximity with the general public, and more. 

Presumption of occupational disease means that if certain groups of employees contract COVID-19, their condition is automatically presumed to be work-related and is covered by workers’ comp as a result. In order to deny coverage for these claims in states with presumption of occupational disease, employers and insurance companies would have to prove that the employee’s COVID case was not workplace related. This goes against what we typically see in workers’ comp, which usually puts this burden of proof on the employee. 

Not every state has these laws, however, so it’s important to check your state’s local legislation. 

Filing a COVID-Related Workers’ Comp Claim

Workers who had (or currently have) COVID-19 and believe it was a result of their job should approach their workers’ comp claim the same way they would any other on-the-job illness or injury claim. However, they should understand that it may or may not be approved depending on their unique circumstances. 

First, the employee needs to notify their employer as quickly as possible and within the regulations outlined by their state’s laws and the employer’s insurance policy requirements. Unless their state and specific line of work has presumption of occupational disease, they’ll need to be able to prove that their job was the direct cause of the COVID and that they were at an increased risk of contracting the virus due to their work. They should provide as much documentation as possible, and keep copies of all medical records and bills. Whether or not the claim will be approved depends on many factors unique to the situation. 

If you’re an employer, check with your insurer to learn more about whether your workers’ comp policy covers COVID-19 for your employees. The answer may depend on the state you operate in, the type of employees you employ, and the policy you have.

About the Author
Craig Shapiro is Vice President, Product & Underwriting for Cerity, a workers’ compensation insurance provider founded with a bold vision to reimagine small- to medium-sized business insurance. With its digital-first approach, Cerity is transforming the entire process to empower business owners to quickly and easily protect their team, assets and livelihood through an online workers’ compensation solution. Follow Cerity on Twitter @CerityisHere.

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