Common Questions About Presumptive Coverage for Health Care and Frontline Workers

Presumptive coverage for COVID-19 health care and frontline workers ended when both the state and federal emergencies ended.

However, some claims may still be considered for presumptive coverage, such as those filed by health care and frontline workers who contracted or were exposed to COVID-19 before the federal and state emergencies ended.

Also, the ending of the federal and state emergencies impacts businesses’ experience modification factor and claim-free discount, and for employers participating in the Retrospective Rating program, their retro adjustment calculations.

These changes affecting workers and employers are discussed in greater detail further down in the Q&A.

President Biden signed a bill ending the federal COVID-19 emergency on April 10, 2023. This ended presumptive coverage for health care and frontline workers, with some exemptions. The state emergency ended on Oct. 31, 2022. Claims for COVID-19 falling outside the presumptive coverage will be considered under standard occupational disease criteria.

Questions About Presumptive Coverage for Health Care and Frontline Workers

When do the laws regarding presumptive coverage apply?

On May 11, 2021, Gov. Jay Inslee signed into law Engrossed Substitute Senate Bill (ESSB) 5115, also known as the Health Emergency Labor Standards Act (HELSA), and ESSB 5190. The laws apply during public health emergencies involving infectious or contagious diseases, such as the COVID-19 pandemic. ESSB 5190 provides presumptive coverage to health care workers exposed to COVID-19 starting Feb. 29, 2020, when Gov. Inslee declared a state of emergency. The HELSA bill applies to frontline workers when both the exposure occurs and the claim is filed on or after May 11, 2021, when the laws took effect. Presumptive coverage for COVID-19 ended on April 10, 2023 when President Biden signed a bill ending the federal COVID-19 emergency.

After the emergency ended, claims for healthcare and frontline workers continue to be considered for presumptive coverage as long as:

The COVID-19 contraction or exposure occurred after the date the coverage became effective up to and including April 10, 2023.
The claim is filed in a timely manner and meets the criteria outlined in state law (RCW 51.28.055).
The claim otherwise meets the criteria for allowance.

Who is a health care worker?

A health care worker is a worker at any health care facility or other organization that provides emergency or medical services and who has or likely has had direct contact with any person who has been exposed or tested positive to the disease.

Who is a frontline worker?

Frontline workers are those who interact with the general public or other employees in the course of their work during the public health emergency. The list includes:

First responders
Workers performing food processing, manufacturing, distribution, or meat packing
Farmworkers
Maintenance, janitorial, and food service workers at any facility treating patients
Public transit drivers and operators
Employees of licensed child care facilities
Employees of retail stores, which remain open to the public during the emergency
Employees of hotels, motels, or other transient accommodation
Restaurant employees who have contact with the public or co-workers
Certified home care aides who work primarily in the home of individuals receiving care
Corrections officers and support employees working at a correctional institution
Certain school district and higher education employees
Public library employees
Department of Licensing employees who are assigned to review, process, approve or issue driver licenses to the public.

More details on front line workers are included in state law RCW 51.32.185

How do I prove I qualify under the new law?

You will be required to provide proof to the Washington State Department of Labor & Industries (L&I) or your self-insured employer that you contracted the disease. Generally, this includes a positive test result from a medical provider.

Could my claim be excluded from coverage?

Your claim may be excluded if there is evidence that you did not contract the disease through your work. This could happen if the disease occurred from other employment or non-employment activities, you were working from home or another location, or you were on leave for a period of time prior to contracting the disease.

What benefits will I receive?

Once a claim is allowed, workers are eligible for medical and disability benefits. Temporary compensation, or time-loss benefits, begins the day after the earliest of the following:

The first missed work day due to symptoms.
The day the worker was quarantined by a medical provider or public health official.
The day the worker received a positive test result confirming contraction of the infectious or contagious disease.

What if I already received benefits from the state or federal government?

Time-loss benefits will not be paid for the same period of time if another federal or state program provided compensation for time missed from work due to the disease (such as the Families First Coronavirus Recovery Act program in 2020).

Do I need to see a medical provider to have a claim for contracting COVID-19 allowed?

It isn't required in most cases where presumptive coverage applies. The law does require you to provide verification that you contracted COVID-19. This can be accomplished by providing L&I with a copy of your positive COVID-19 test results.

L&I can accept a test result from:

Your employer if they administer the test and record the date and result.
A pharmacy.
A county health department or other temporary testing facility.
Other commercial locations that are providing testing.

L&I cannot accept a self-administered home test. The test must be performed and recorded by a medical provider or one of the parties in the list above.

L&I accepts both Rapid Antigen Tests (RAT) and Polymerase Chain Reaction (PCR) tests for verification that you have contracted COVID-19.

Most claims for COVID-19 resolve with time and home care and never require a medical provider's treatment. If this is not the case and your illness lasts beyond the typical quarantine period, you will need to have an attending medical provider who can coordinate any needed treatment as well as certify the need for additional time away from work.

What if I'm not a frontline worker or health care worker, but I contract COVID-19 or I am required to quarantine by a medical provider or public health officer?

Contraction of a disease that is the subject of a public health emergency is not presumed to be work-related for those who are not frontline or health care workers. Claims for these workers are reviewed on a case-by-case basis to determine whether the worker had a greater likelihood of contracting the disease because of the job duties. There must also be a documented or probable work-related exposure.

How do I file a claim?

Workers for employers insured through L&I can file a claim online, by phone, or with a paper Report of Accident available from their medical provider.

Learn how to file a claim.

Workers for self-insured employers should contact their employer to obtain a Self-Insurer Accident Report (SIF-2). Their employer can discuss the claim process in detail. If you have additional questions, contact Self-Insurance Training at 360-902-6904.

Do the cost of COVID-19 claims, including a reaction to a COVID-19 vaccine, impact a business's experience modification factor and claim-free discount (if applicable)?

For COVID-19 claims with a date of injury or exposure on or after July 1, 2023, all losses will be included in the determination of a business’s experience factor and a business could lose their claim-free discount. The first year an allowed COVID-19 claim with a date of injury or exposure on or after July 1, 2023 can impact a business’s experience rating is 2026.

All losses for allowed COVID-19 claims with a date of injury or exposure before July 1, 2023 are not included in the determination of a business's experience modification factor. A business will not lose their claim-free discount as a result of an allowed COVID-19 claim with a date of injury or exposure before July 1, 2023.

What is the impact to retrospective rating calculations for losses from COVID-19 claims?

The losses for allowed COVID-19 claims with a date of injury or exposure on or after January 1, 2026 will be included in the retro adjustment calculations. This will first affect standard premiums in 2026 with enrollments beginning April 2025. The losses for allowed COVID-19 claims with a date of injury or exposure before January 1, 2026 are not included in the retro adjustment calculations.

Where can I find more information about HELSA worker safety and health requirements?

L&I's Division of Occupational Safety and Health (DOSH) is leading the work to implement worker safety and health requirements and protections under HELSA. This includes employer reporting of disease outbreaks in the workplace, protection of high-risk employees from discrimination, and notifying employees of potential exposure in their workplace. Email EyeOnSafety@Lni.wa.gov with questions about these worker safety and health requirements and protections.