Is COVID a valid workers comp claim?

1,986 Views | 11 Replies | Last: 5 yr ago by lazuras_dc
boboguitar
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AG
My wife got tested yesterday and we don't know the result, however, it seems several people at her clinic have tested positive and she will be quarantined if her test comes back positive.

With that said, it's extremely likely, if she has it, she contracted it at work. Is that a valid claim? She will be losing a lot of money if forced to be quarantined.
agdaddy04
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AG
Why wouldn't she be paid for two weeks on the CARES act?
boboguitar
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AG
agdaddy04 said:

Why wouldn't she be paid for two weeks on the CARES act?
I guess she would? I haven't actually looked into it. We just found out about the outbreak in the clinic yesterday.
TXTransplant
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In short, yes, but worker's compensation would apply if she is injured and unable to work (and if there are associated medical bills).

Unemployment may cover if she can't work because she's been sent home to quarantine.

It's not clear if simply testing positive is considered an "injury" (which is probably why this is all being determined on a case by case basis).

Quote:

Q: Does workers' compensation cover coronavirus-related exposure or illness?
A: Workers' compensation is an insurance program that pays for medical bills and some lost-time income for employees who have a work-related injury or illness. To qualify, an employer must have workers' compensation insurance, and an employee must have been injured or contracted an occupational disease as a result of their employment. Whether a workers' compensation claim is compensable or not is a case by case determination by the insurance carrier. If there is a dispute over a claim and you are not able to resolve the dispute with the insurance carrier, then you may ask for dispute resolution by contacting DWC.


https://www.tdi.texas.gov/wc/information/faqie.html
CardiffGiant
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AG
My wife works for a large well known insurance carrier and is a client service manager in the healthcare part of the business. I do know this depends on the state and the circumstances. Normally worker's compensation requires you to prove you were injured during course and scope of your work. Example would be your work requires you to go to the hardware store to pick things up. If you throw out your back while picking up some lumber it would be covered. If you deviate from course and scope by going to help someone put something in their car and get injured in the process that would not be covered under worker's compensation.

When COVID first started many worker's comp claims due to infection were denied because there was no way to prove the worker contracted the illness while attending to patients vs heading to work. This is especially true in NYC where most people take the subway or other forms of mass transit to get to work. This fluctuated back and forth (at least in NY) for a short while but I think most states are now accepting worker's compensation claims for COVID positive healthcare workers without much pushback.

My advise would be to file the claim. The insurance carrier will then work with her employer to investigate circumstances and determine if it's compensable.

What state do you live (and work in if different)?
lazuras_dc
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AG
FFCRA- familes first coronavirus response act will allow employers to to pay salary for 2 weeks if diagosed or quarantined or have a family member diagnosed. employer gets payroll tax credits back so its nothing lost out of their bottom line.
culdeus
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lazuras_dc said:

FFCRA- familes first coronavirus response act will allow employers to to pay salary for 2 weeks if diagosed or quarantined or have a family member diagnosed. employer gets payroll tax credits back so its nothing lost out of their bottom line.


What about non profits.
BCR
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My daughter worked 2 weeks on the Covid floor at her hospital. Woke up today with diarrhea. They furloughed her until she gets 2 negative test. Her boss told her she had to use PTO.

Maybe that will change if she tests positive.
momlaw
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AG
Doubtful an employer can enforce PTO when it is employer mandated time off.
Employees may fall for or acquiesce for various reasons.
My first salvo, if job secure, might be, "so you want me to file for unemployment?"
momlaw
Lily09
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AG
I was told yesterday at work that if I tested positive and stayed asymptomatic then I am expected to still be at work. If I am symptomatic and test positive then I have to use my own PTO for as long as I have to be off. Even if I've taken care of a COVID patient.
permabull
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AG
permabull
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AG
lazuras_dc
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hypeiv said:

lazuras_dc said:

FFCRA- familes first coronavirus response act will allow employers to to pay salary for 2 weeks if diagosed or quarantined or have a family member diagnosed. employer gets payroll tax credits back so its nothing lost out of their bottom line.
It only applies for companies with 50-500 employees, so most people don't qualify


That's not my understanding. for the efmla you can opt out if under 50 employees if it will it Wil "jeopardize viability" of the business. But for the epsl you are unable to opt out (as easily) of that even if less than 50. https://www.lexology.com/library/detail.aspx?g=7cabeadd-568d-4e2c-b957-785df37936a1

To OP here's a link that may be helpful https://www.hrforhealth.com/blog/covid-19-employer-questions-part-1
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