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Coronavirus (COVID-19) and California’s Workers’ Compensation Law—What You Should Know

As with any work exposure that results in injury, time off work, and the need for medical treatment, there can be a claim made for contracting COVID-19 at work.   As with any work-injury claim, there must be evidence that the virus was contracted arising out of and in the course of one’s employment.   If you suspect a work-related exposure, it is legally appropriate to file a Workers’ Compensation claim with your employer.

The first step would be to obtain, complete and submit a DWC-1 Form (Workers’ Compensation Claim Form) to your employer; a verbal report is not sufficient to initiate a claim. 

Coronavirus and Workers Compensation Cases

Upon receipt, the employer is to process the claim with his/her insurance company within 24 hours and refer you out for medical care.  The law then allows the insurance company to decide within 14 days if it is going to accept, reject or delay the claim.  In most cases, the claim will be denied for lack of medical evidence connecting the virus exposure to work. However, if it is delayed, the insurance company has 90 days from receipt of the claim form to issue a decision as to whether the claim is accepted or rejected.

If the claim is denied, you will not receive any financial compensation for time off (temporary disability) or medical treatment through the Workers’ Compensation system. Because time is of the essence to receive medical treatment, you will need to pursue medical care on your own. You can pursue the process of trying to prove the claim later.

If the claim is delayed, during the delay period the insurance company has to pay up to $10,000 in medical treatment (before the claim is denied).  However, no money for time off (temporary disability) is owed during the delay period.

Even if the claim is accepted, under state law the first three days of temporary disability are not paid until the injured worker has been out for 14 days.  Payments are then initiated and are paid every two weeks thereafter.   For a summary of Workers’ Compensation temporary disability benefits click here.

In most cases, even a validly filed Workers’ Compensation claim may take months or longer to determine eligibility for benefits (medical treatment and temporary disability).

As a result, it is imperative that those who are exposed and ill, and unable to work, should consider applying for State Disability Insurance through the California Employment Development Department if you paid into that system.  Alternatively, if you or your employer has paid into any short-term or long-term disability policy that may be applicable, you may want to look into that.

According to news reports, the government is developing a plan to make unemployment benefits available to those unable to work due to the virus infection.  This may also be an option for you.

If you are intending to pursue a claim, be sure to keep a paper trail of all your medical treatment, and keep your employer informed of your medical and work status. 
As these issues remain fluid, we will try to continue to keep the community educated and informed. 

 

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