5 Things to Know about COVID-19 and Claim Composition

Orlando, FL (WorkersCompensation.com) -- With the Workers’ Compensation Institute’s 2021 conference set to kick off Dec. 12, the question of COVID-19 and claim composition is on the agenda. In their Monday afternoon session, the Impact of COVID-19 on Workers’ Compensation Claim Composition, John W. Ruser, President and CEO of the Workers’ Compensation Research Institute, and Alex Swedlow, President of the California Workers’ Compensation Institute, will explain what the pandemic has meant for the industry and state systems’ responses.

Ruser and Swedlow recently addressed the state of claims in the pandemic’s “new normal” and what WCI attendees can expect from their session.

What do people need to know about COVID-19 and workers' compensation claim composition that they probably don't or don't know enough about?

Contrary to early expectations, COVID-19 claims have accounted for a low percentage of total claims costs across states. 

COVID-19 claims are fundamentally different from non-COVID-19 claims:

• Much lower average indemnity benefit per claim
• Many claims had no medical payments
• Claims concentrated in certain industries

There was a large drop in the number of non-COVID-19 claims, particularly early in the pandemic, but those that occurred tended to have longer temporary disability duration.

The delivery of medical care for non-COVID-19 claims was not delayed due to the pandemic.

Only 1 in 20 Californians of working age (18-65) with COVID-19 acquired the infection at work.

The infection rate “waves” in California workers’ compensation mirrored the population wide infection waves. 

What lessons have been learned so far during the pandemic?

The workers’ compensation systems have shown themselves to be resilient in the face of a new medical condition, both in ensuring coverage and medical treatment for injured workers generally and appropriately covering workers who may have contracted COVID-19 at work.

Sharp decreases in non-COVID claim volume were largely made up by COVID-19 claims

The high rate of reported COVID-19 claim denials in California were due mostly to negative COVID-19 tests and exposure outside of the workplace.

COVID-19 fatalities in California made up 54 percent of all workplace fatalities and had higher proportions of older workers and female workers than non-COVID fatalities. 

What, if any, lessons should still be learned but maybe aren't on "the radar"?

As we noted, most COVID-19 claims have proven to be associated with low cost and no medical.  It remains to be seen, however, how many COVID-19 claims might show persistent or recurrent symptoms that result in higher cost for a small subset of COVID-19 claims.

The pandemic has created disruptions in labor markets, both in terms of how we do our work (working from home) and labor turnover (high quits and job openings) that may impact the nature of injuries, temporary disability duration, and may create wage pressures that will ultimately manifest in higher indemnity payments.   

How will group health and federal programs administer coordination of benefits and Medicare Set-Asides for post-acute COVID symptoms and illnesses?

How will permanent disability settlements be influenced by the evolving understanding of post-acute COVID symptoms and illnesses? 

What changes have come to workers' compensation claim composition from COVID-19 that could stay beyond the pandemic's end (whenever that is)?

A number of states put in place presumption laws, regulations, and policies stipulating that certain groups of workers who contract COVID-19 are presumed to have contracted the disease at work. While presumptions for various conditions such as PTSD and cancers were on the books in some states prior to the pandemic, it remains to be seen whether the emphasis on COVID-19 presumptions might increase the use of presumptions for a variety of conditions in the future.

Case law challenging the intersection of COVID-19 workplace safety programs, infection transmission, exclusive remedy, and the “derivative” rule. 

What do you hope attendees will take away from your session?

Attendees will learn how the pandemic has impacted claims for both COVID-19 and non-COVID-19 in the past and some thoughts about what the future may bring.

How well, under the circumstances, the workers’ compensation industry responded to the evolving challenges of a societal pandemic. 

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