COVID-19 Workers’ Comp Claims Grow, While Overall Claims Plummet

covid-19 claims

While the number of COVID-19 workers’ compensation cases filed in California continues to grow, total workplace injury and illness claims in the state have fallen nearly 20% so far in 2020 compared to 2019.

Through September, the state had recorded 47,412 COVID-19 workers’ compensation claims, accounting for 11.1% of all claims reported since the start of the year. During that same period, California workers filed 425,280 workers’ compensation claims, down 19% from the first nine months of 2019.

The first COVID-19 cases among California workers were filed in March. They peaked in July and started to decline in August just when parts of the state started opening up on a partial basis. Numbers have continued to fall as you can see at a glimpse of claims counts as of Oct. 21:

  • March: 2,994 (ultimate projected cases for the month: 3,127).
  • April: 4,215 (ultimate projected: 4,382).
  • May: 4,880 (ultimate projected: 5,135).
  • June: 11,761 (ultimate projected: 12,752).
  • July: 14,098 (ultimate projected: 15,253).
  • August: 5,973 (ultimate projected: 6,770).
  • September: 3,316 (ultimate projected: 5,334).

While it’s too early to tell if it’s a harbinger of things to come, the numbers are high enough that employers cannot let their guard down when it comes to preventing the spread of the coronavirus in their workplaces.

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: 16,889 claims (37% of all claims)
  • Public safety/government workers: 6,902 claims (15%)
  • Manufacturing: 3,759 claims (8.3%)
  • Retail workers: 3,593 claims (7.9%)
  • Transportation: 2,255 claims (5%).

Overall claims falling

Due to the severe economic slowdown brought on by the coronavirus pandemic that forced thousands of businesses to shut their doors or have their workers work from home, the number of overall workplace injuries has tumbled.

There were a total of 425,280 workers’ compensation claims filed in California in the first nine months of the year, compared to 526,469 claims in the same period of 2019. That’s a drop of 19.2%. The caseload in September dropped 30% compared to September 2019.

“That decline reflects both the sharp drop in employment, the high number of workers now working from home, and the pandemic-driven slowdown in economic activity in the state,” the California Workers’ Compensation Institute wrote in a report about the numbers.

Handling workers’ comp claims

A new law that took effect in September extends workers’ compensation benefits to California employees who contract COVID-19 while working outside of their homes.

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 June 6.
  • The 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.

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.

State Fund to Accept All COVID-19 Claims by Essential Workers

essential worker

State Compensation Insurance Fund has announced that it will accept any workers’ comp claims for a diagnosed case of COVID-19 filed by essential workers.

Workers deemed “essential” who contract COVID-19 would be presumed to have caught the virus at work, and hence would be eligible for all normal workers’ comp benefits under the law.

Only workers for employers who are insured by State Fund will benefit from the decision by the insurer. But that could change.

Gov. Gavin Newsom is considering issuing an executive order that would require a presumption that any case of infection by an essential worker is work-related and eligible for workers’ compensation benefits. That would include partial wage replacement for any missed time from work, as well as covering all related medical costs and death benefits for their family should the unthinkable happen.

State Fund had earlier created the Essential Worker Support Fund to partially cover any workers it insures, but the new action replaces that fund so that workers who file COVID-19 claims are entitled to all the same benefits (indemnity for lost wages and medical costs related to treating the virus, including hospitalization if needed).

“We currently estimate these added benefits will require approximately … $115 million,” State Fund said in its announcement, adding, “We will still provide temporary disability benefits to any covered essential worker who must self-quarantine if they are not covered by another source.”

State Fund’s new rule only applies to cases that were filed by essential workers who have been on the job since Newsom issued the shelter-at-home order on May 19. The rule will be pulled once the order is lifted.

Essential employees include those who work in food, warehousing, delivery, agriculture, health care, energy, emergency services, and more.

Good news for workers, employers

The move by State Fund and the possible executive order are good news for workers as well as employers. Any essential worker that currently contracts COVID-19 would otherwise have a steep hill to climb in trying to prove that they caught it at work unless they are health care workers or first responders.

Not only that, but the case can get tied up if the employer challenges the claim and it goes to the Workers’ Compensation Appeals Board for adjudication.

It would be good news for employers too, as the Workers’ Compensation Insurance Rating Bureau has proposed its own rules that would exempt any COVID-19 claims from an employer’s claims history so that it would not affect their experience modifier (X-Mod).

That means if an employer has any employees who file COVID-19 claims, their premiums would not rise due to those claims.

The Rating Bureau estimates that the cost of COVID-19 claims in California could range from $2.2 billion to $33.6 billion annually. A mid-range estimate of $11.2 billion would equate to more than 60% of all California workers’ comp annual claims before the pandemic.