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Workers’ Compensation and COVID-19: Using Medical Experts/Consultants to Understand Claims

Workers’ Compensation and COVID-19: Using Medical Experts/Consultants to Understand Claims

Workers’ compensation insurance carriers are feeling the impact of the COVID-19 pandemic as thousands of coronavirus claims have been filed in recent weeks.  Officials in multiple states have created carve-outs which allow workers who believe they contracted COVID-19 on the job to file claims for benefits.  For example, in California, those workers eligible will have the rebuttable presumption if they tested positive for COVID-19 or were diagnosed with COVID-19 and confirmed by a positive test within 14 days of performing a labor or service at a place of work after the stay at home order was issued on March 19. This presumption will stay in place at least through July 5, 2020.  The California rebuttable presumption will entitle employees to full benefits for medical treatment, hospital/surgery expenses, disability indemnity, and death.  The order does not indicate how employers are expected to rebut the presumption.

California is not the only state to enact special policies pertaining to COVID and workers’ compensation and occupational health.  The governors of Kentucky, Arkansas, North Dakota and Florida and state regulators in Illinois, Washington, Michigan and Missouri have issued executive orders or amended rules to expand eligibility for workers’ compensation and occupational health claims (while Illinois tried to create a rebuttable presumption in favor of “frontline” workers who acquired COVID-19 on the job, courts recently struck down that effort).  In some of these jurisdictions, the ability to file a COVID-19 workers’ compensation claim is limited to “frontline workers”.  However, that term can be broadly defined to include more than health care workers and first responders.  In Illinois, “frontline workers” includes those employed by grocery stores, laundries, banks, and hardware stores, among other businesses.

Workers’ compensation insurance claims examiners, adjusters and respondents’/defense attorneys may choose to rely on medical expert witnesses and experts in occupational health to evaluate COVID-19 related workers’ compensation claims.  Health care specialties that will be critical to understanding these claims include:  Occupational Medicine, Public Health, Infectious Disease, Epidemiology.  Claimants attorneys may also benefit from consulting with the experts in the aforementioned health care and medical fields, especially where causation is an issue in a contested claim.  AMFS and its network of COVID-19 medical expert witnesses and consultants is at the forefront of connecting the legal community to the best-qualified experts to help plot strategy and address workers’ compensation claims related to the COVID-19 pandemic.

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