Things you should know
COVID-19 updates: Claims, Insights from research reports
Claims
- California: In 2020, 19% of claims filed were related to COVID-19 and the number just about offset the drop in non-COVID claims. Of the COVID-19 claims, 7.7% included hospital stays, with costs averaging $70,317 for an average 13-day stay.
The number of claims reported to the state Division of Workers' Compensation (DWC) for February 2021 fell to the lowest level in a year and the projected ultimate claim count for February came in at 4,533 cases, down nearly 90 percent from the record 43,158 claims projected for December 2020.
- Florida: COVID-19 claims steeply declined in February to 1,019, down from 3,816 reported in January and 4,327 reported in December 2020. Overall, 43.9% of indemnity claims paid in the first two months of 2021 were for COVID-19 infections, up from the 32.2% reported for the entire year of 2020. Total benefits, medical plus indemnity, paid in the first two months of 2021 stood at $2.6 million. In 2020, comp payers paid a total of $71.6 million in COVID-19 claims. (Florida Division of Workers' Compensation)
- Texas: As of Feb. 14 insurers reported 44,873 COVID-19 related claims and 200 related fatalities. Forty-nine percent of the claims with positive tests or diagnoses were denied. Indemnity or income replacement costs soared past that of medical, $21.2 million compared to $13.4 million.
Insights from research reports
- Key findings reported in a NCCI brief on aggregated, multistate results for COVID-19 metrics data from the third quarter of 2020 (3Q20) include: the number of active workers' comp claims in the third quarter of 2020 ticked up from the 2nd quarter, but was lower than the same period in 2019; there are no "meaningful" delays before initial treatment despite the COVID-19 pandemic; hospitalization and intensive care unit (ICU) treatment are key cost indicators of COVID-19 claims; telemedicine took a slight step back but remained significantly higher than 2019; and drug share of medical costs and utilization of opioids changed direction, reversing previous increases.
- A study of 24,000 workers conducted by four universities of four large health care systems between April and August 2020 found that the majority of COVID-19 exposures resulted from outbreaks in the community, not in the workplace. The researchers found that health care workers who worked in a COVID-19 unit or with COVID-19 patients did not increase their odds of contraction and that there was no clear association between workplace contact with coronavirus patients and a positive antibody test.
- The pandemic did not cause treatment delays for non-COVID claims as access to treatment for injured workers remained relatively unchanged from the previous year, according to data presented by the Workers Compensation Research Institute (WCRI) at its annual conference.
Construction injuries related to the time of day/shift
A new report from researchers from Oregon State University used workers' compensation claims from the state's construction industry from 2007 to 2013, examining more than 12,000 claims in which a work-related injury or illness caused at least three missed days of work, overnight hospitalization, likely permanent disability or death.
They found that the frequency of injuries increased in each of the first four hours of a shift and peaked during the fourth hour. Workers who started their shift in the evening or at night were more likely to experience injuries and suffer more severe injuries than daytime workers, based on lost workdays and medical costs.
NCCI report on the impact of CMS changes to reimbursement rules and rates on workers' compensation
According to a recent NCCI report, the Centers for Medicare & Medicaid Services (CMS) made significant changes to reimbursement rules and rates for medical services in 2021 that can impact workers' compensation fee schedules, depending on how states link their fee schedule to Medicare.States that use fee schedules that are partially based on Medicare's payment rules (such as Texas, Georgia, Oklahoma, Colorado) could see an increase in total medical costs of up to 2%. For states including Florida, Tennessee, and North Carolina that make few, if any, changes to Medicare's rules will likely see an increase, but less significantly.
State News
California
- Department of Fair Employment and Housing (DFEH) recently issued guidance on whether employers can require workers to receive a COVID-19 vaccination. Employers must engage in an interactive dialogue with employees who have a disability-related or religious reason for refusing an FDA-approved vaccine. However, an employee who doesn't "trust that the vaccine is safe" doesn't have to be accommodated.
- The Office of Administrative Law approved proposed changes to the Division of Workers Compensation's medical-legal fee schedule, which substantially overhauled the current reimbursement system for workers comp evaluations. All medical-legal valuations occurring on or after April 1 will be subject to the new fee schedule.
- Signed March 19, a new law guarantees access to paid sick leave for eligible workers impacted by the COVID-19. The law extends protections through Sept. 30 and is retroactive to Jan. 1. Establishments with 25 or fewer employees are exempt, but may offer supplemental paid sick leave and, if eligible, receive a federal tax credit.
Florida
- Gov. Ron DeSantis signed into law SB 72, a "shield law" that protects businesses, health care providers, schools, religious institutions, and public entities from COVID-19 liability, provided they made a good-faith effort to follow "authoritative or controlling government-issued health standards or guidance."
New York
- A new law requires that all employees receiving a vaccine on or after March 12, 2021, must receive a paid leave of absence, at their regular rate of pay, for "a sufficient period of time" not to exceed four hours per vaccine injection. The new law, which applies to private and public employees (with potential carveouts for employees subject to a collective bargaining agreement) sunsets on Dec. 31, 2022. FAQs clarify that the law does not create retroactive benefits.
North Carolina
- The Industrial Commission, in a notice posted to its website, said that effective March 1, all carriers, third-party administrators, and self-insured employers are required to provide an email address that is used to receive claim-related documents.
Oregon
- Made permanent a temporary order that provides state-paid leave for employees who need to quarantine or self-isolate because of COVID-19 exposure or are experiencing symptoms, but do not qualify for COVID-19-related paid sick leave or do not have access to COVID-19-related paid time off.