COVID 19 and Worker’s Comp – Are You Covered?

As an employer or employee, it is our sincere hope here at Builtwell Insurance that you have not had ask this question yet.  However, the reality of this virus is that people are getting sick and some are dying, so it is best to be prepared should the rare event occur for you. The best answer to this question is that you will not actually know until a claim is made.  As with any claim, it will need to be reported to the insurance carrier, then an investigation will be conducted as to whether or not it is a covered loss.  The wrong answer, is to make the determination on your own, and to not notify the carrier before a claim is made.

This issue is being hotly debated in many states, and some legislatures are considering bills that would specifically name this disease as well as future pandemics, as being compensable, but the debate is still ongoing and a national ruling has not yet been made.

Historically, diseases spread via contact and are untraceable to the workplace. Diseases like the flu, hepatitis or even the common cold were not covered under workers comp due to the fact these types of communicable diseases could not be directly related to the workplace.  Here is an excerpt from the Tennessee code that defines “Occupational Disease”:

50-6-301. “Occupational diseases” defined. [Applicable to injuries occurring prior to July 1, 2014.]

(a) As used in this chapter, “occupational diseases” means all diseases arising out of and in the course of employment. A disease shall be deemed to arise out of the employment only if:

(1) It can be determined to have followed as a natural incident of the work as a result of the exposure occasioned by the nature of the employment;

(2) It can be fairly traced to the employment as a proximate cause;

(3) It has not originated from a hazard to which workers would have been equally exposed outside of the employment;

(4) It is incidental to the character of the employment and not independent of the relation of employer and employee;

(5) It originated from a risk connected with the employment and flowed from that source as a natural consequence, though it need not have been foreseen or expected prior to its contraction; and

(6) There is a direct causal connection between the conditions under which the work is performed and the occupational disease. Diseases of the heart, lung, and hypertension arising out of and in the course of any type of employment shall be deemed to be occupational diseases.

(b) Cumulative trauma conditions, hearing loss, carpal tunnel syndrome, and all other repetitive motion conditions shall not be considered an occupational disease unless such conditions arose primarily out of and in the course and scope of employment. The opinion of the physician, selected by the employee from the employer’s designated panel of physicians pursuant to §§ 50-6-204(a)(4)(A) or (a)(4)(B), shall be presumed correct on the issue of causation but said presumption shall be rebutted by a preponderance of the evidence.

In summary, the correct thing for an employer to do when presented with an employee making a claim of injury or illness they claim occurred due to or as a result of their job is to file a ‘first report of incident’ to their insurance carrier, so that the process flows properly to a conclusion.

If you have any doubts about a situation arising form Covid-19 or understanding the claim process, call your Builtwell Insurance agent and we will help you through any difficulties.