Influenza Claims Under the Industrial Insurance Act

Effective Date: October 15, 2024

Background

Seasonal influenza is an acute respiratory illness caused by influenza A or B viruses and occurs every year, mainly during the winter season. When an influenza virus that normally infects animals is found in people, it is called a variant influenza virus. Though it is uncommon for people to get influenza virus infections directly from animals, sporadic human infections and outbreaks caused by certain avian and swine (variant) influenza A viruses have been reported. The 2009 H1N1 Pandemic was caused by an influenza A virus with a unique combination of influenza virus genes that can spread easily from person-to-person.

When to file a claim

The Industrial Insurance Act allows for treatment of influenza in cases in which work-related activity has resulted in probable exposure of the worker to influenza virus and contraction of the condition. In these cases, there must be a greater likelihood of contracting the disease on the job, a documented or probable work-related exposure, and an employee/employer relationship.

Before filing a workers’ compensation claim, the treating provider should consider if these criteria are met:

• Was there an increased risk or greater likelihood of contracting the condition due to the worker’s occupation? (e.g., first responder or health care worker)
• If not for their job, would the worker have contracted the condition?
• Can the worker identify a specific source or event that resulted in exposure to influenza virus while performing their job duties? (e.g., first responder or health care worker who has actually treated a patient with the flu.)

If these 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 whether the criteria are met.

When the contraction of influenza is coincidental to the workplace, or caused by conditions of everyday life or all employments in general (e.g., an office worker who contracts the condition from a coworker), a claim for exposure to influenza and contraction of the disease will likely be denied.