| How does L&I handle seasonal and H1N1 influenza cases? |  | |
Will L&I accept claims for employees who are exposed to — or actually contract — either seasonal or H1N1 influenza on the job?
Only if the employee:
- Was exposed to the virus on-the-job.
and - Has a job that requires them to be exposed to this virus, such as a health care worker.
and - L&I has documentation confirming the worker was exposed to the virus at work.
and - A medical doctor has specifically diagnosed the illness as influenza.
How will L&I decide if the influenza was caused by the employee’s particular job, and not by an exposure at home or some other location?
L&I claim managers will consider the following factors:
- Did the worker have a greater risk or likelihood of contracting the influenza because of their occupation?
- Could the worker have contracted the condition anyway, if they did not work at their particular job?
- Is there documentation showing the worker was directly exposed to the influenza virus while doing required job duties -- and did the examining doctor indicate it was probable (a 51 percent or more chance) that performing required job duties exposed the worker to the influenza virus? (An example of an on-the-job exposure would be a first responder or healthcare provider who was directly exposed to a patient with H1N1 while doing their job.)
What if the worker has a documented, on-the-job exposure, but does not become ill?
In this case, L&I must deny the claim, but will consider paying preventative medication, on a case-by-case basis.
When would an employee’s claim for influenza not be covered by workers’ compensation benefits?
If an employee contracted the virus from an office co-worker, for example, they were exposed at their workplace. However, their exposure was unrelated to the type of work they do. In these cases, L&I could not accept their claim or pay for preventative medication.
For more detailed information on claim validity and when the insurer may authorize post-exposure prophylaxis, treatment, and/or testing on influenza claims, please go to Provider Bulletin 09-08.
