We are nine months into the COVID-19 pandemic, and it is clear workers’ compensation systems around the nation are unlikely to go back to operating the way they did before March 2020.
There is concern that workers’ compensation insurers will try to use exclusions to get out of providing benefits to workers who contracted COVID-19 on the job. There are concerns that something needs to be done to avoid knee-jerk reactions like this by insurance companies.
“What you’re probably going to have with the COVID illnesses are insurance companies trying to also enforce exclusions,” said Schmidt Kramer Partner Scott Cooper. He was quoted in an article on the CBS 21 website.
Insurance companies are claiming they cannot predict a virus that is an exclusion, which prevents them from paying out benefits to workers who catch the virus or suffer another injury related to the pandemic.
Unfortunately, insurance companies have used exclusions before to deny coverage. This happened to many first responders who were injured or died because of 9/11. Insurance companies said they did not need to cover injuries caused by terrorism, which led to the federal government creating a 9/11 compensation fund, Cooper said. It is possible something similar may happen because of the COVID-19 pandemic.
As of Monday, there were 9,035 COVID-19-related workers’ compensation claims in Pennsylvania. According to the National Council on Compensation Insurance, two of every 100 cases may involve permanent partial disability. About one of every 2,000 claims is likely to result in permanent total disability. These are the most expensive cases for insurance companies and employers.
At this point, insurance companies will be presumed to be required to cover a claim filed by a health care worker or first responder, said Cooper. The burden of proof will be on the employer to prove the worker did not contract COVID-19 on the job.
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