May 26, 2020

CWCI Explores Integration of COVID-19 Claims

The California Workers’ Compensation Institute (CWCI) published a new report that discusses aspects and challenges of integrating COVID-19 presumptions into the workers’ comp system, following Executive Order N-62-20 which greatly expands coverage for COVID-19.

This report utilizes a survey that gathered information on COVID-19 claims filed as of April 30, 2020, prior to the Executive Order. CWCI states that prior to the Order, the California workers’ compensation system was evaluating and adjudicating compensability consistent with the order, meaning that this preliminary data could help estimate potential impacts to the workers’ comp system.

This survey was distributed to 16 insurance companies and 12 self-insured organizations, totaling 1,077 reported claims.  Approximately 27.7% of those reported claims were accepted. Reasons for denials included:

  • 69.7% of claims had negative results on COVID-19 tests
  • 14.5% of claims had a lack of exposure at work
  • 15.8% of claims had other reasons

According to the report, there was confusion among employers in regards to when to report a suspected COVID-19 illness, as some survey respondents reported instances where claims were filed for groups of workers without symptoms or positive tests because a co-worker reported symptoms.

The report also goes on to discuss proposed legislation included in Senate Bill 1159 which seeks to expand COVID-19 presumptions beyond the Executive Order, exploring potential impacts if that bill were passed.

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