Questions About Workers' Compensation Coverage and Coronavirus (COVID-19)
This information is meant to answer many of the questions L&I is receiving regarding workers' compensation coverage and this new disease.
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.
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.
Can COVID-19 ever be allowed as a work-related condition?
Gov. Jay Inslee signed into law two 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.
Gov. Inslee declared a public health emergency on February 29, 2020. The emergency ended on Oct. 31, 2022.
On April 10, 2023, President Biden signed a bill ending the federal COVID-19 emergency. This ended presumptive coverage for health care and frontline workers.
Claims for healthcare and frontline workers may continue to be considered for presumptive coverage so long as:
- The contraction or exposure occurred after the date the coverage became effective up to and including April 10, 2023.
- The claim is filed timely per RCW 51.28.055.
- The claim otherwise meets the criteria for allowance.
Claims for COVID-19 falling outside the presumptive coverage will be considered under standard occupational disease criteria.
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 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.
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).
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 may 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. Claims for vaccine reactions are considered industrial injuries and must be filed within one year of the vaccination to be considered for allowance.
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.
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)?
Not for allowed COVID-19 claims with a date of injury or exposure prior to July 1, 2023. 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.
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.
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 before January 1, 2026 are not included in the retro adjustment calculations. 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.
Additional information on COVID-19
For up-to-date information on COVID-19, go to the following websites: