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COVID-19 claims that acceptance is lower than predicted



It has been more than eight months since the COVID-19 pandemic began in the United States and the effects on workers' compensation claims continue to be less than predicted, experts say.

In large parts of the country, the number of COVID-19 work compensations has been accepted – even in the 17 states with a presumption law or executive order that allows workers to claim to have contracted the virus at work – has not been very high or

Illinois, despite having a presumption law with one of the broadest networks, has not seen the large influx of claims that was expected, says Rich Lenkov, capital member and head of employee compensation practices at Bryce. Downey & Lenkov LLC in Chicago . He estimates that COVID-1

9 claims accounted for less than 5% of the total claims he has seen in his internship this year.

"I represent many companies that employ first responders, hospitals, and we see more (claims) than average, but not to the extent that many initially thought," he said.

of accepting allegations if it is obvious that an exposure occurred at work, he said, but most of his clients have tended to be "quite skeptical" about whether allegations arose out of and during employment due to the "pervasive pandemic. It is difficult to find exactly where an employee may have been exposed. For the most part, we question a relationship to work. "

In California, coronavirus claims fall into three different categories: those covered by the assumption that Gavin Newsom's government introduced by executive order between March 19 and July 5, claims covered by the less expansive presumption law that came into force on July 6, or people who were not covered by either because they acquired the pre-executive order, says Robert McLaughlin, owner and partner of the McLaughlin & Sanchez APC in Chula Vista, California, which represents workers.

But "most people do not claim," he said. "Most of the clients I've talked to openly say they do not think they got it from work."

According to the California Workers' Compensation Institute, the state saw nearly 54,000 COVID-19 claims from March to October. . With the exception of the months of June and July, however, the number of coronavirus claims accounted for less than 5.5% of total claims. COVID-19 receivables accounted for 10.5% of total receivables in June and 12.2% in July. About 30% of COVID-19 claims were denied – the rest have either been accepted or are waiting.

In a presumption state, adjusters who want to disprove claims look closely at two ways, either direct family exposure or what an employer has done to protect their workforce from COVID-19, says Matt Zender, Las Vegas-based senior vice president of workers' compensation strategy for AmTrust Financial Services Inc.

Although COVID-19 claims that the frequency has been higher in states that have codified an assumption of compensatory capacity for certain workers, such as caregivers and first-line interventions, there is the possibility to refute based on measures taken by employers, such as implement clearly documented security protocols, Zender said.

Having such a workplace policy in place is "generally a good defense against even a rebuttable presumption," Lenkov said.

Several states without enactment laws show that coronavirus claims tend to be a low p percent of total damage costs. Between January and October, the Florida Division of Workers' Compensation reported a little more than 23,000 COVID-19 claims, representing 31% of all claims but accounting for only 8% of total benefits as a percentage of total compensation. The majority of approved COVID-19 claims were submitted by healthcare professionals, first-time staff and security service workers and service industry personnel, according to the division.

In Texas, the Workers Compensation Research & Evaluation Group found that insurers reported more. than 25,000 COVID-19 claims and accepted slightly less than half of all positive test claims, with most claims involving first responders and detectives. The state had no figures available to compare coronavirus claims with overall claims.

The Ohio Bureau of Workers' Compensation received only 1,718 COVID-19 claims between March 11 and September 16, with the majority filed for first responders and care. worker. Of these claims, BWC accepted 400 claims and denied 118. Approximately 400 claims were voluntarily withdrawn by employees, and 192 are pending. Self-insured employers in the state accepted 319 claims and rejected 188, with 97 pending, according to the agency's data.

Most of the Ohio coronavirus claims have come from healthcare, but they have also come from grocery store, manufacturing and law. enforcement workers and most complainants have returned to work, said Patricia Harris, chief operating officer at the Ohio Bureau of Workers' Compensation. Currently, about 80 denials have been appealed to the Ohio Industrial Commission, she said.

BWC created a team of half a dozen employees to address all COVID-19 claims.

"We thought it was better to have a team as opposed to different people making decisions," she said. "That way, we had consistency in our approach to how we examined the issues and made decisions."

More insurance and labor compensation news about the coronavirus crisis here . Catalog

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