COVID–19 and Workers’ Compensation

By Jeff Rush, Workers’ Compensation Program Manager

The COVID-19 pandemic has created a lot of issues for risk managers and human resource professionals, including its impact on the workers’ compensation system. This article will address some of the most frequently asked questions about employees who have been exposed to COVID-19.

What should I do if one of my employees has been exposed to or contracted COVID-19?

If one of your employees believes they have been exposed to COVID-19 or is exhibiting symptoms of COVID-19, you should find out if they feel the exposure is somehow related to their employment. If they feel their exposure and/or symptoms are work-related, they should be provided with a DWC-1 form and referred for testing. Many occupational medicine clinics are not currently providing testing so you may need to refer your employee to their own personal physician or to your county health department to obtain testing.

How do I report a claim for COVID-19?

If your employee is asymptomatic or declines medical treatment, you should make a record of the incident and submit an Employer’s First Report of Occupational Injury or Illness (Form 5020) to Sedgwick, our third-party administrator. They will create a record only claim in their claims system in the event your employee experiences any problems in the future. If you receive a completed DWC-1 from your employee, you should also complete an Employer’s First Report of Occupational Injury or Illness and submit it to Sedgwick. In these cases, they will set up a claim and assign a representative to assist your employee through the process.

Are COVID-19 claims covered under workers’ compensation?

Employees are afforded workers’ compensation benefits for compensable claims for occupational disease. Coverage for compensable occupation disease claims is provided to California JPIA members participating in our primary and excess programs. The issue of compensability for these claims is a complex one. Existing case law finds that employees whose work is shown to put them at increased risk for occupational diseases such as COVID-19 are more likely to have a claim deemed compensable.

What happens if my employee decides to file a claim?

If your employee elects to file a claim, it will be placed on delay and investigated by our claims team at Sedgwick. During the delay period, your employee is eligible for up to $10,000 of medical treatment (including testing). While they are not eligible for any indemnity benefits (such as temporary disability or Labor Code 4850 benefits) during the investigation period, they may be eligible for replacement of lost wages under the Families First Coronavirus Response Act.

If my employee’s claim is accepted, what benefits will they receive?

Employees with a compensable claim are eligible for treatment that is necessary to cure and relieve the effects of COVID-19. If your employee misses time from work, they would be eligible for temporary disability (or Labor Code 4850 benefits for public safety officers). If the employee sustains any residual effects from the injury, the employee may be eligible for permanent disability. Additionally, employees with compensable claims who are unable to return to work because of COVID-19 would be entitled to a supplemental job displacement voucher. If the employee passes away as a result of a compensable COVID-19 claim, their survivors would be eligible for death benefits.

How is COVID-19 affecting the workers’ compensation system?

Employees with existing claims are experiencing delays in treatment, especially if they need to undergo surgery. There are also delays associated with depositions and court appearances at the Workers’ Compensation Appeals Board.

What about employees working from home?

Employees working from home are eligible for injuries sustained in the course and scope of employment. If an employee working at home contracts COVID-19 and files a claim, it would be investigated in accordance with the procedures outlined above.

What if I have additional questions?

The California JPIA provided a webinar on April 1, and that recording is available our website training catalog. There are also additional resources available at this link.