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Adopting trend that changes the industry: Panelists



The trend of assumptions about workers' compensation may be a turning point for the industry, according to presenters at a Tuesday session of the Risk & Insurance Management Society Inc conference 2021.

Dozens of states have adopted assumptions for some workers – mostly first respondents – suffering from various cancers, heart disease or post-traumatic stress disorder. And now COVID-19 can be compensated in some cases, with employers on the hook to cover infections that have probably been contracted in the workplace.

Sixteen states currently have such COVID-19 assumptions in place and several more are considering them, retroactive. to the beginning of the pandemic in March 2020.

Assumptions pose challenges for employers in part because "COVID-1

9 is something you can be exposed to anywhere," said presenter Max Koonce, chief executive officer of third-party administrator Sedgwick Claims Management Services Inc. [19659002] "The risks of COVID-19 are simply associated with the risks of everyday life," he said. "If you are with an employer for eight hours a day, you have sixteen other hours a day that you are out in the environment when you may be exposed to it just going on with your life."

He briefly described similar challenges regarding cancer assumptions and the inherent risk that approximately one third of adults will develop cancer during their lifetime.

Such assumptions are problematic in that they are a "broad brush" for compensability, said Joan Vincenz, Executive Vice President of Business Risk for United Airlines Inc., which has introduced COVID-19 safety measures for workers such as the Centers for Disease Control and Prevention. introduced them.

"Because every recommendation has been implemented, we implemented it," she said.

Most of the COVID-19 assumptions can be refuted, which means that if an employer can prove that the worker was infected elsewhere, it can deny the claim. According to some state laws, if an employer takes all precautionary measures, the claim can be refuted, Vincenz said, adding that this "intention" – to ensure that employers take precautionary measures seriously – is understandable.

Ms. Vincenz said there are things that employers cannot control that make her "uncomfortable with the assumptions." She stated that living environments or activities that are not in service can expose someone to COVID-19 and that "sometimes it is safer" for an employee to be at work due to the safety measures available.

"We do everything we can. … We can not control the home environment. That's where I do not think assumptions meet the intention," she said. "Like the flu, it's hard to say where you got it."

Asked by Mr. Koonce if the trend toward assumptions is "changing the dynamics of workers' compensation?" Mrs. Vincenz said, "I think it could."

"It is always dangerous to use a wide brush; it's about the details "about an injury, she said. “We must be ready to examine each (claim) and make sure you decide on the merits. … That's what I think assumptions risk removing. ”

More insurance and work compensation news about the coronavirus crisis here .

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