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)
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.
Presumptive worker’ compensation coverage for contraction of or quarantine due to COVID-19 ends when both the state and federal public health emergencies are lifted.
Health care and frontline workers will continue to be eligible for presumptive coverage until the president of the United States declares an end to the federal public health emergency.
After the emergency has ended, claims for health care and frontline workers may continue to be considered for presumptive coverage so long as:
- The contraction or exposure occurred between the date the coverage was effective and the end of the emergency.
- 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).
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 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.
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: