Claims Insights/FAQs

Are COVID-19 claims covered by workers compensation?

Coverage for any particular claim will depend on the jurisdiction and the specific facts and circumstances of the claim.  Workers compensation coverage applies to bodily injury by disease, provided the bodily injury by disease is caused or aggravated by the conditions of employment and the employee’s last exposure occurs during the policy period.

In most jurisdictions, workers compensation coverage does not apply unless an employee has a greater risk of infection than the general public due to the nature of the employee’s work. For example, an employee in the healthcare industry may have a greater risk of COVID-19 infection, depending on the nature of the work.

I thought COVID-19 is a virus like a cold or flu, so why do I have to report COVID-19 claims?

COVID-19 is a global pandemic and in some states COVID-19 is considered an Occupational Disease and may be covered under your Workers Compensation policy.  The rules and guidelines vary by state and may also vary on factors such as employee’s exposure to COVID-19 and test results.  Most states require that the exposure occur while working for employer outside the home and that tests results are positive.

Should you report a claim if an employee has possible exposure to COVID-19?

No, exposure alone does not constitute an industrial injury. A claim should be reported if the employee advises you that they have a positive COVID-19 test OR a COVID-19 diagnosis from a physician and the employee believes that they contracted it at work. Once the claim is reported, it will be addressed on its own individual merits

Should you report a claim if your employee who was allowed to work from home for the last month advises you that they have tested positive for COVID-19?

No, you do not need to report the claim unless your employee advises you that they have a positive COVID-19 test OR a COVID-19 diagnosis and that they believe that they contracted it at work.

Should you report a claim if your employee who has been working outside of their home calls in sick because they have COVID-19 symptoms?

No, a claim should only be reported if there was known exposure OR the employee claims symptoms are due to work and there is a positive COVID-19 test OR a positive COVID-19 diagnosis.

Should you report a claim if your employee notifies you that they have tested positive for COVID-19 after working on your behalf outside of their home?

Yes, you should report a claim if your employee notifies you that they have a positive COVID-19 diagnosis after working on your behalf outside of their home. Once you are notified, follow the appropriate reporting guidelines for your state and report the claim to us for handling.  For California, this includes providing a DWC1 claim form to the employee and reporting the claim.

Should you report claims for other employees who worked with the affected employee within 14 days?

No, you do not need to report claims for the other employees who worked with the affected employee unless they report symptoms and have tested positive for COVID-19.

Are indemnity benefits available for COVID-19 claims?

If the claim is covered, the available benefits would depend on the jurisdiction and the specific facts and circumstances of the claim.