COVID-19 Claims Growing Among California Workers

workers' compensation claims

The number of COVID-19 workers’ compensation claims in California has seen a steady climb, reaching a total of 31,612 from when the pandemic started until the end of July, according to the latest figures from the Division of Workers’ Compensation.

In July, 9,515 California workers filed COVID-19 workers’ compensation claims, as well as 74 coronavirus-related worker deaths ― bringing the total to 140 fatalities. The total claims account for 10% of all claims filed between January and July, despite the first claims being filed only in March.

These numbers are fluid and are certain to grow as more claims are filed after the fact, as there are often time lags in claims filings.

For example:

May claims ― As of July 6, there were 3,889 claims, but as of Aug. 10 the number had risen to 4,606.

June claims ― As of July 6, there were 4,438 COVID-19 workers’ comp claims. But as of Aug. 10, that figure for June claims had more than doubled to 10,528. 

Based on these claims development stats, the California Workers’ Compensation Institute projects there could ultimately be 29,354 COVID-19 claims with July injury dates and 56,082 COVID-19 claims with January through July injury dates.

Who is filing claims?

The top five sectors reporting COVID-19 workers’ compensation claims during the first seven months of the year are:

  • Health care workers (40% of all claims)
  • Public safety/government workers (6%)
  • Retail workers (8%)
  • Manufacturing (7%)
  • Transportation (5%).

Handling workers’ comp claims

In early May, Governor Gavin Newsom signed an executive order extending workers’ compensation benefits to California employees who contract COVID-19 while working outside of their homes during the state’s stay-at-home order.

To qualify for the presumption, all of the following conditions must be met:

  • The worker must test positive for or be diagnosed with COVID-19 within 14 days after a day they worked at your jobsite at your direction.
  • The day they worked at your jobsite was on or after March 19.
  • Your jobsite is not their home or residence.
  • If your worker is diagnosed with COVID-19, the diagnosis was done by a medical doctor and confirmed by a positive test for COVID-19 within 30 days of the date of the diagnosis.

Even when an employee is presumed to have become ill from COVID-19 at work, the employer may dispute that conclusion. In such a case, however, you bear the burden of proving that the injury or illness did not occur at work.

The executive order does not apply to COVID-19-related claims, regardless of date of injury, that were accepted by the claims administrator as compensable prior to May 6.

All of the typical workers’ compensation benefits apply:

Medical care ― Reasonable and necessary medical treatment paid for by your employer to help you recover from an injury or illness caused by work.

Temporary disability benefits ― Payments if you lose wages because your injury prevents you from doing your usual job while recovering.

Permanent disability benefits ― Payments if you don’t recover completely.

Supplemental job displacement benefits ― Vouchers to help pay for retraining or skill enhancement if you don’t recover completely and don’t return to work for your employer.

Death benefits – Payments to your spouse, children or other dependents if you die from a job injury or illness.

The takeaway

If you have an employee who is working on site and who tests positive for COVID-19, you should let them know about their rights to file for workers’ compensation if they miss work and/or need treatment.

The state’s insurance commissioner has approved new rules that bar insurers from using any COVID-19 claims against your experience modifier (X-Mod), so it won’t hurt your workers’ compensation experience if a worker files a claim.

New Law Significantly Changes When Injuries Must Be Reported to Cal/OSHA

Injury claim report

Gov. Gavin Newsom has signed a measure into law that will greatly expand when employers are required to report workplace injuries to Cal/OSHA.

The new law, AB 1805, broadens the scope of what will be classified as a serious illness or injury which regulations require employers to report to Cal/OSHA “immediately. As of yet, there is no effective date for this new law, but observers say regulations will first have to be written, a process that would start next year.

The definition of “serious injury or illness” has for decades been an injury or illness that requires inpatient hospitalization for more than 24 hours for treatment, or if an employee suffers a “loss of member” or serious disfigurement.

The definition has excluded hospitalizations for medical observation. Serious injuries caused by a commission of a penal code violation (a criminal assault and battery), or a vehicle accident on a public road or highway have also been excluded.

The new rules

The new rules being implemented by AB 1805 are designed to bring California’s rules more in line with Federal OSHA’s regulations for reporting. Here are the new rules:

  • Any inpatient hospitalization (even less than 24 hours) for treatment of a workplace injury or illness will need to be reported to Cal/OSHA.
  • For reporting purposes, an inpatient hospitalization must be required for something “other than medical observation or diagnostic testing.”
  • Employers will need to report any “amputation” to Cal/OSHA. This replaces the terminology “loss of member.” Even if the tip of a finger is cut off, it’s considered an amputation.
  • Employers must still report any serious disfiguration to Cal/OSHA.
  • Loss of an eye must be reported.
  • Serious injuries or deaths caused by a commission of a penal code violation must now be reported.
  • While the exclusion for injuries resulting from auto accidents on a public street or highway remain in effect, accidents that occur in a construction zone must now be reported.

Compliance

Rules for reporting serious injuries and illness or fatalities are as follows:

  • The report must be made within eight hours of the employer knowing, or with “diligent inquiry” should have known, about the serious injury or illness (or fatality).
  • The report must be made by phone to the nearest Cal/OSHA district office (note that a companion bill, AB 1804, eliminated e-mail as a means of reporting because e-mail can allow for incomplete incident reporting).

Because of the “diligent inquiry” component, employers should monitor an injured worker’s condition once they learn of an injury, particularly if they need to seek out medical treatment. A member of the staff should be on hand to monitor the employee and report to supervisors immediately if that person will need to be hospitalized.

Employers should make sure that supervisors are made aware of the new rules so that any time a worker is injured to the point that they need to be hospitalized, they know to notify Cal/OSHA within eight hours.

Also, if you have an employee that suffers a medical episode at work – such as a seizure, heart attack or stroke – you are required to report the hospitalization to Cal/OSHA.

It’s better to err on the side of caution if an employee is hospitalized for any reason. Not doing so can result in penalties for failure to report or failing to report in a timely manner.

Accordingly, it is important to educate management representatives, particularly those charged with the responsibility to make reports to Cal/OSHA, about the nuances of Cal/OSHA’s reporting rules.

One final note: The results of a serious injury or illness or workplace fatality will usually trigger a site inspection by Cal/OSHA.