coronavirus workers comp claim

Does Workers’ Comp Cover Coronavirus?

If you contract COVID-19 at work, you may have a compensable Pennsylvania workers’ comp (WC) claim. However, it might not be the easiest route to financial relief.

This blog touches on the process, proofs, and pecuniary benefits of pursuing a workers comp claim.

First Things First

If you believe you’ve contracted COVID-19 at work, the first step in pursuing a workers comp claim is to notify your employer of that belief. Failure to timely notify your employer could result in the claim being permanently extinguished. After notifying your employer, the workers comp carrier will be contacted, and will need to investigate the claim and make a decision to accept, deny, or provisionally accept (accepted, but still needs to be verified) the claim, within 21 days. After this is done, it's might be prudent to consult with a workers comp lawyer near you.

Providing Proof for a Workers Comp Claim

This is where the proofs come in. Under the WC injury provisions, an injured worker needs to establish that the COVID-19 virus was contracted at work, or while the worker was in the course and scope of their employment, even off of the employer’s premises. A travelling employee may have a much more broad “course and scope” than a stationary employee. The employee also needs to establish that the exposure was “related” to the employment.

With COVID-19 being essentially everywhere, proving that the exposure was work related may be challenging. On the other hand, health care workers and emergency services personnel may have an easier time making their case because of obvious exposures. In addition, under the occupational disease standard of the Workers’ Compensation Act, the employee needs only to initially show that the presence of COVID-19 is more prevalent in that occupation. In either event, medical support for your claim is necessary.

If the COVID-19 claim is denied, the process leads to litigation which starts with filing a workers compensation claim with the Bureau of Workers’ Compensation. An injured worker is usually best served to involve knowledgeable injury lawyer to assist them through this process.

Workers Comp Benefits for a COVID-19 Claim

All of this begs the question, what does the injured worker get for the effort of going through this process? With modifications to new and enhanced wage replacement benefits due to the unprecedented COVID-19 pandemic, someone who suffers wage loss due to COVID-19 may be in for a long and complicated battle.

The primary benefits of workers’ comp are wage loss benefits resulting from the illness and medical bills related to the illness. There are certain limitations though. Wage loss benefits are typically two-thirds of an employee’s average weekly wage. There are exceptions. There is also a waiting period.

If the employee loses no more than seven (7) days, no wage loss benefits are payable. On the eighth (8th) day wage loss is payable. If the employee simultaneously receives unemployment compensation (UC), the employer gets a dollar for dollar credit for the UC paid. Please see the High Swartz blog, Can I Collect Unemployment Compensation During the Coronavirus Pandemic?

Regarding medical care, the employee must treat with the posted panel of physicians for the first ninety (90) days of treatment or the bills may not be paid. In the extreme case, workers comp does pay a death benefit to dependents.

FFCR Coverage for COVID-19

Employees should also be aware that effective April 2, 2020, an additional, or alternative, Federal benefit is available for paid leave related to the Coronavirus. The Families First Coronavirus Response Act provides for a wage loss benefit caused by the Coronavirus whether contracted at work or not. Coverage under the FFCR is more broad than the WC Act, but the benefit cap is lower than workers compensation. In any event, receipt of both benefits will undoubtedly be coordinated with credits for one against the other. Please see the High Swartz blog, How the Families First Coronavirus Response Act Will Affect Local Business

Talk with a Workers Comp Lawyer

In summary, lost time wage replacement and payment for related medical care resulting from COVID-19 illness may be covered by workers comp, but subject to the above process and proofs. Benefits will be coordinated with other employer sponsored plans to allow for recovery but not double-recovery.

The benefit landscape directly related to COVID-19 and Coronavirus is changing daily. The new Federal, State, and Employer sponsored benefits may eliminate or mitigate the need to file a workers comp claim. On the other hand, for long term wage loss or death claims, where dependent benefits are at stake, a workers comp claim may be necessary.

If you have any questions or concerns, talk with a workers comp lawyer near you or here at High Swartz in our Doylestown law office. Our law firm provides legal services to clients in Bucks and Montgomery Counties.

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