The Centers for Disease Control and Prevention (CDC), the Washington State Department of Health (DOH), and other public health agencies are responding to an outbreak of respiratory disease known as new coronavirus, or COVID-19.
The complete clinical picture regarding this public health emergency isn't fully understood. Reported illnesses have ranged from mild to severe, including cases and deaths in Washington.
This information is meant to answer many of the questions L&I is receiving regarding workers' compensation coverage and this new disease.
Questions About Workers' Compensation Coverage and Coronavirus (COVID-19)
Will my scheduled time-loss payments continue?
Yes. If you can't work due to your work-related injury or illness, then your time-loss payments will continue. If anything changes that may affect your benefits, a claim manager will contact you.
How can I get information about the status of my claim?
Get automated information about your claim in English or Spanish (en Español) by calling 1-800-831-5227 or through the Claim & Account Center.
Will an order and notice become final and binding if I did not have access to mail when my business was closed?
The time period to protest or appeal an order doesn't start until the order is communicated. If you cannot access the order through no fault of your own, you must provide the claim manager with some evidence or an explanation such as you couldn't get your mail during a specific time period.
Can medical and vocational appointments be conducted by telephone?
My attending physician won't see me right now and my certification for time-loss benefits has expired. What do I do?
We realize that many health care providers are postponing non-priority appointments. Ask your provider if they offer telehealth options or if you can check in with them by telephone. Your claim manager will evaluate the information available and continue to pay time-loss benefits for a period of time. It's important to keep your claim manager informed.
My treatment plan was put on hold. How does this affect my claim?
Your claim will not be closed if you need further treatment. We will allow time for you to complete your treatment plan when medical services resume.
Note: Our system automatically closes some claims for "medical benefits only." If this happens and you have not completed your treatment, contact your claim manager, who can help make sure your claim remains open so you can finish your treatment.
I would like to postpone or reschedule an independent medical evaluation (IME) because I'm concerned about the coronavirus outbreak. What do I do?
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.
Is it appropriate to cancel or postpone a medical appointment or procedure because of concerns about coronavirus?
Contact your health care provider to find out what they recommend. Many providers are offering telehealth. If the appointment can safely be postponed, tell your claim manager.
How do I know if I’m at high risk for serious illness if I contract COVID and how do I know what to do to protect myself and my family from COVID-19?
The Centers for Centers for Disease Control and Prevention or CDC provides comprehensive COVID-19 information about who is at greater risk for serious illness and how a person can best protect themselves and their families.
Since my child's school has closed, I don't have child care and need to postpone a medical or vocational appointment. What do I do?
Please make every effort to arrange for child care so you can attend a medical or vocational appointment for your claim. If all efforts fail, contact your vocational rehabilitation counselor (VRC) or medical provider to see if they can conduct your appointment by phone or another method. Keep your claim manager informed. We will make every effort to allow you time to reschedule your appointment.
I am concerned about going to class or participating in my retraining program because of the virus. What do I do?
Contact your VRC, who will contact your school or trade program and explore options. It may be possible to study at home or pursue other alternatives. Your VRC will keep L&I informed.
My temporary light-duty job is no longer available because of the virus. What do I do?
Contact your claim manager immediately. We recommend you submit a time-loss notification form through the Claim & Account Center.
Assuming there are no other changes, your claim manager may verify information and you may be eligible for time-loss benefits, or your employer may choose to keep you on salary.
I was laid off from my job because of the coronavirus outbreak and have an open claim. How does this affect my benefits?
Appropriate medical treatment on your claim can still be approved. If medical treatment is delayed, your claim will not close. We know medical providers are postponing appointments, and we will allow you time to complete your treatment before closing your claim.
If you were working without medical restrictions, you are not eligible for time-loss benefits. In this case, you may be eligible for unemployment benefits through the Employment Security Department.
I've been released for work, but I don't have a job to return to, and the job market is limited due to the coronavirus outbreak. What do I do?
Unfortunately, we cannot pay time-loss benefits once you have been released for work or are found able to work. In many cases, you may be eligible for unemployment benefits through the Employment Security Department. Your claim manager can direct you to other community resources to look for a job.
Can COVID-19 ever be allowed as a work-related condition?
Gov. Jay Inslee signed into law 2 bills that grant presumptive workers' compensation protections to health care and frontline workers during a public health emergency, such as the COVID-19 pandemic. The new laws mean that it will be presumed health care and frontline workers contracted a contagious or infectious disease at work when they file a workers' compensation claim.
Other claims that meet certain criteria for exposure will be considered on a case-by-case basis.
Once a claim is allowed, workers are eligible for medical and disability benefits.
The insurer (L&I or a self-insured business) will pay for treatment of COVID-19.
Appropriate, medically required testing would also be covered. This is a time-limited benefit, and no benefits would be paid after the worker tests negative for COVID-19 or the quarantine period has ended, unless the worker develops the disease.
Compensation for allowed claims
For health care and frontline workers who contract the disease, temporary wage replacement, or time-loss benefits, begins 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.
For other allowed claims, time-loss payments for lost wages during a quarantine period may be available for up to 14 days; however, the first 3 days are not paid unless the worker is medically required to remain off work on the 14th day following exposure. The CDC indicates that COVID-19 symptoms may appear anywhere from 2 to 14 days after exposure.
When to file a claim
The Industrial Insurance Act allows for treatment of COVID-19 when work-related activity has resulted in probable exposure to the virus and certain criteria are met. In these cases, the worker's occupation must have a greater likelihood of contracting the disease because of the job. There must also be a documented or probable work-related exposure, and an employee/employer relationship.
Before helping a worker file a workers' compensation claim, the treating provider should consider if the following criteria are met:
- Was there an increased risk or greater likelihood of contracting the condition due to the worker's occupation?
- If not for their job, would the worker have been exposed to the virus or contracted the condition?
- Can the worker identify a specific source or event during the performance of his or her employment that resulted in exposure to the new coronavirus?
If the above criteria are not met, it is not necessary to file a workers' compensation claim; however, a claim may still be filed if requested by the worker or if the provider is uncertain if the case meets the criteria.
When will a claim likely be denied?
When the contraction of COVID-19 is incidental to the workplace or common to all employment (such as an office worker who contracts the condition from a fellow worker), a claim for exposure to and contraction of the disease will be denied.
How can I file a COVID-19 claim?
- Online via our FileFast tool.
- By phone: 1-877-561-3453 (FILE).
- At your doctor's office (if you complete the Report of Accident at your doctor's office, the doctor files the form for you).
If your patient is insured through L&I, you should fill out a Report of Industrial Injury or Occupational Disease (ROA), either:
- Online via FileFast: Recommended, as you can bill an additional $10 (code 1040M).
Find out why we recommend online claim filing, how it works, and how it helps your patients.
- Fax a paper copy within 2 days to 1-800-941-2976 or 360-902-6690. Order forms online.
- If your patient is insured through a self-insured business, you should fill out the Provider's Initial Report (PIR) (F207-028-000).
For self-insured claims, send the Provider's Initial Report (PIR) and related chart notes to the self-insured employer (SIE) or their third party administrator (TPA).
Filing a worker's compensation claim: Exposure vs. contraction of COVID-19
Workers exposed to COVID-19 must submit the appropriate accident report form before the insurer (L&I or the self-insured business) can pay for treatment or time-loss benefits. The same is true if the worker is unable to work during the quarantine period or is ill from the virus.
While in most cases, L&I expects to receive claims for contraction of COVID-19, the Industrial Insurance Act allows the insurer to pay for testing before someone is ill when there's been a documented, work-related exposure.
If the diagnosed condition on the original accident report form is contraction of COVID-19 and the 3 criteria under When to file a claim are satisfied, the claim will be allowed and treatment authorized.
When a claim is filed for probable exposure and the criteria under When to file a claim are satisfied, the claim will be allowed for the quarantine period whether or not the worker actually contracted COVID-19.
Workers do not need to be examined by a physician for a COVID-19 exposure claim to be submitted when they are quarantined. L&I is handling medical documentation for these claims differently than other workers' compensation claims. However, we do require a positive test to allow a claim for the disease when a worker has actually contracted the virus.
If you have additional questions, send us a secure message through the Claim & Account Center. If you do not have access to the Claim & Account Center, leave a telephone voice message, and we will get back to you as quickly as possible.
Can a worker file a claim for a reaction after being vaccinated for COVID-19?
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.
If a claim is allowed for a reaction to a COVID-19 vaccine, is the worker entitled to time-loss benefits?
Yes. However, unlike claims presumptively covered for COVID-19, a worker will not be paid for the first 3 days after the vaccine was administered, unless the worker is medically required to remain off work on the 14th day after the vaccination.
Will a business's experience rating or premium assessments be affected for the costs of a claim for a reaction to a COVID-19 vaccine?
No. The cost of claims allowed for COVID-19 vaccine reactions will not affect the experience rating of businesses insured by L&I. Self-insured businesses may deduct the costs of these claims from the total claim costs reported for administrative assessment purposes.
Additional information on COVID-19
For up-to-date information on COVID-19, go to the following websites: