Answers for self-insured businesses about workers’ compensation coverage during the COVID-19 pandemic.
These laws impact health care and frontline workers who contract contagious or infectious diseases that are connected with a public health emergency. Under the laws- if these workers file workers' compensation claims after becoming sick it will be presumed that they contracted the disease on the job.
Self-Insurance and Coronavirus (COVID-19) Common Questions
- Was there an increased risk or greater likelihood of exposure or contracting the disease due to the worker’s job duties?
- If not for their job, would the worker have been exposed or contracted the condition?
- Can the worker identify a specific source or event during their employment that resulted in exposure to COVID-19?
- The first missed work day due to symptoms;
- The day the worker was quarantined by a medical provider or public health official, or;
- The day the worker received a positive test result confirming contraction of the infectious or contagious disease.
No. There is no waiting period. All days except for the date the disease was contracted may be payable for claims that meet the presumption laws (RCW 51.32.181 and RCW 51.32.390). This includes the “first three days”. This is unique to claims filed as a result of public health emergencies involving infectious or contagious diseases.
Yes. Both laws have presumptive coverage which may be challenged if the employer can show that the worker did not contract the disease through their job. For health care workers, the standard of evidence to challenge presumptive coverage must be “clear and convincing.” For frontline workers, “preponderance” of evidence is the standard.
Yes, a worker may file a claim, but there is no presumption of coverage.
Claims will be allowed for employees who have a reaction to the vaccine when it is required by the employer and/or by government order, rule, or law as a condition of employment. Other claims will be evaluated on a case-by-case basis.
Contact your claim manager at least 5 business days before your appointment to find a solution. IMEs can be postponed in some cases if, for example, you are at high risk for serious illness from the virus or have recently been exposed to or contracted COVID-19.
Up-to-date CDC travel recommendations can be found here: https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html.
Yes, it is possible. The following questions will be used to help determine if a claim will be allowed for a worker who is not in a job or at facility where exposure would be routinely expected:
When exposure to or contraction of the disease is incidental to the workplace or common to all employment, the claim will likely be denied.
Yes. If a PIR is received, a SIF-2 form should be filed. The self-insured employer should request for the claim to be allowed if it meets the presumption or the criteria detailed above.
No. If a self-insured employer receives a PIR, a SIF-2 form should be filed. If the worker is a health care worker, claim allowance should be requested. For other workers the employer may request an interlocutory order -- a non-final order that is issued while the case is still pending -- until results from the testing are received.
If the worker is health care worker, then the claim should be allowed. For other workers, if the employer paid the employee their regular salary during the quarantine period and the worker receives negative test results, no further action is needed.
Yes, if the employee is a health care worker or if the employee meets the criteria. If the employer does not pay the employee their regular salary, the employer must pay time-loss benefits to the employee for the quarantine period, up to 14 days. And, the employer is required to provide a SIF-2 form and assistance with filing a claim.
COVID-19 claims are considered occupational disease exposures. The date of manifestation is whichever occurs first of the following:
Call L&I's main phone number for self-insurance: 360-902-6901.
L&I encourages self-insured employers to use Secure File Transfer (SFT), instead of sending paper files. To set up this service, contact us.