Tag Archives: covid-19 impact on workers comp

COVID-19’s Impact on Delivery of Care

Two forces have emerged that will reshape the workers’ comp system for years to come. The first is the COVID-19 pandemic, which has created sudden and deep shifts to personal health practices and healthcare delivery. To reduce COVID-19’s impact, much of the U.S. population is avoiding public spaces and travel, causing enormous disruption across a range of industries, from airlines to hospitality. This change has ignited a global recession.

Together, COVID-19 and the accompanying recession are driving changes across property and casualty insurance lines, including workers’ compensation, causing carriers, reinsurers and third-party administrators to rethink long-held assumptions. Companies hoping to navigate all of this need to anticipate and prepare.

To help, we held a Q&A session with some of the smartest people in the business who sit on our advisory panel. Special thanks go to Dan Rufenacht, QBE North America; Will LaChapelle, QBE North America; David Bacon, QBE Insurance; Kevin Bingham, Chesapeake Employers’ Insurance; and Jim Kinzie, QBE Insurance. Below is a summary of responses outlining the most fundamental changes to plan for. Let us know what you think — and what your team and company are doing to adjust to this new and dynamic environment.

What are the major changes we should anticipate in workers’ compensation claims due to COVID-19?

The experts on our panel highlighted several ways that workers’ comp claims will change, many of which are related to shifts in volume and type of claim. For example, the total number of claims is likely to go down as unemployment increases. There are fewer people in the workforce, which will lead to fewer claims overall, particularly as work involving manual labor slows.

Although the volume of typical workers’ comp claims will decrease, claims for different types of injuries could escalate. There will almost certainly be an increase in occupational disease claims from workers on the front line of fighting COVID-19 (e.g., police, fire, healthcare workers.). There is emerging pressure in some states and regions/provinces to extend coverage for workers being asked by employers to extend services or responsibilities for essential businesses. There is also the potential for new ergonomic claims and other types of accidents as people adjust from working in an office to working from their bed or couch and sitting for prolonged periods. Additionally, there is a risk for the select businesses hiring new workers — there could be an increase in frequency and severity of claims if workers are inexperienced or can’t be properly trained based on conditions. On top of this, there may be some spikes in preventable accidents, resulting in new claims, if safety service visits have been canceled due to COVID-19, leaving potentially dangerous areas exposed.

Organizations should also expect to see several changes in treatment patterns emerge, as care delivery will undoubtedly be affected under the strain that COVID-19 places on healthcare systems. Most non-essential surgeries, physical therapy sessions and scheduled doctor visits are tabled for the foreseeable future. This will delay the path to health for injured workers and delay the resolution of many claims. However, telemedicine and tele-rehab solutions are being implemented in an attempt to mitigate the effects of delayed treatment. The key here with telehealth options will be ensuring that access to and the effectiveness of care delivered to injured workers remains similar to, if not greater than, the same care provided in-person with the treating doctor or therapist.

See also: Business Continuity During COVID-19  

The shift to telemedicine and tele-rehab is an example of how present stresses are opening the doors for innovations. Telehealth options and digital resistance that insurers and the larger healthcare community have been fighting over for years have suddenly become possible within the course of only a week because they are necessity-driven. At least one panelist welcomed the opportunity, adding that “the old rules of ‘we can’t direct treatment’ are ripe for breaking just now.”

How are claims teams gearing up to handle these changes? Are there parallels that come to mind?

To prepare, claims teams are keeping a close eye on the new claims coming in — the type and volume — to ensure proper resourcing and reporting. New organization structures are also being considered. For example, some organizations are considering bringing some of the claims processing that previously had been outsourced to places like India and the Philippines back in-house — and possibly permanently. The benefit of this move is to open new jobs at home, which can offer good flexibility as employees work remotely.

Also, based on behavior in past crises, the panel noted that claimants are under a lot of additional stress; therefore, it is imperative that claims teams show empathy and compassion. We are all trying to navigate an unprecedented situation, and people are doing the best that they can.

Any impact on other types of claims due to the stresses on the healthcare environment?

Panelists instantly noted how much pressure first responders are under. These workers are covered in many states under presumption laws, which can include PTSD. If so, according to our experts, there will likely be an increase in claims from first responders soon.

Any advice for claims professionals?

Panelists offered several thoughts, including:

  • Remember to stick to the basics: Conduct quality and complete investigations and thoughtful compensability evaluations. Use common sense and empathy and talk to peers and managers to manage stress and determine the best ways to help claimants.
  • Look for opportunities and new or different treatments and delivery channels that can provide relief in lieu of surgery, as almost all non-emergency surgeries have been postponed or canceled.
  • Watch how other lines indirectly and directly affect workers’ comp. For example, health insurers will be inundated with all kinds of pre-hospital, hospital and post-hospital expenses. If they can get workers’ comp to pay for these costs, it may become more important to them.

See also: Chaos in a Post-Yesterday World!  

With things evolving on a daily basis, how do we keep abreast of all the changes going on? Are there any specific resources you use?

Our experts rely on several proven and reliable industry blogs, association websites, attorney newsletters, state bulletins and other alerts to stay on top of the industry — in addition to daily news broadcasts and updates. Some listen to podcasts, as well. Sources include general business and technology, in addition to verticals.

To help, we compiled a list of some of the most useful industry-specific content mentioned:

I would like to extend my great thanks to all of our advisory panel members for sharing their insights in this turbulent time.

COVID-19’s Impact on Workers’ Comp

During this pandemic, many workers (nurses, police, grocery store clerks, transit professionals, etc.) are considered essential, potentially putting them at heightened risk for contracting COVID-19. A key question, of course, is whether a worker who contracts COVID-19 is compensated under workers’ compensation for income loss and medical expenses. 

Below are some frequently asked questions that get posed to me as president and CEO of the Workers Compensation Research Institute (WCRI). We’re an independent, not-for-profit research organization that provides high-quality, objective research and statistical information about public policy issues involving the various state workers’ compensation insurance systems in the U.S. 

Q1: Is COVID-19 covered under workers’ compensation and, if not, why not?

A1: Historically, communicable diseases, like the flu, have generally not been covered.  Workers’ compensation covers injuries and illnesses that arise out of and in the course of employment. It is generally difficult to establish work-relationship for a disease that could be contracted anywhere. Indeed, some states’ statutes bar compensation for communicable diseases. In the past few weeks, though, a number of states have taken steps to expand workers’ compensation coverage to include COVID-19 for certain groups of workers.

Q2: What is the course of action for states seeking to cover essential workers affected by COVID-19?

A2: Some states consider that their current laws, regulations and procedures are sufficient to provide compensation for workers who demonstrate that they contracted COVID-19 at work. Other states have changed their rules, either by executive order or legislation, to increase the likelihood that a worker who contracts COVID-19 may be eligible for workers’ compensation. The states vary in terms of the scope of workers covered and in terms of the burden of proof required by an ill worker to establish work-relatedness. A number of states’ laws and orders cover only first responders or healthcare workers. Others expand coverage to include other groups of workers deemed to be essential, e.g., grocery workers. In some states, the worker may be eligible for workers’ compensation if the worker can demonstrate that the illness was the result of his employment or occupation. In other states, for the workers covered, there is a presumption that their illness arose from work, though that presumption can be rebutted.

Q3: Is this the first time coverage has been expanded for conditions that may arise outside of work?

A3: No. For example, we have seen workers’ compensation coverage expanded to include those, particularly first responders, who witness a traumatic experience and as a result have post-traumatic stress disorder (PTSD) and can no longer perform their duties. 

Q4: Is workers’ compensation administered at the state or federal level?

A4: Individuals injured on the job while employed by private companies or state and local government agencies are covered by workers’ compensation programs administered by the states. The essential features of the states’ workers’ compensation systems are similar, but they may vary in terms of the compensability of some conditions, the amount of benefits paid and other features. Federal and some other workers are covered by four disability compensation programs administered by the U.S. Department of Labor.

See also: Impact of COVID-19 on Workers’ Comp  

Q5: What does workers’ compensation cover, and are the benefits across the country the same?

A5: Workers’ compensation covers all medical benefits and wages lost while off work due to the injury. It covers the first dollar of medical care, and there are statutory formulas for the income benefits that replace lost wages. WCRI’s workers’ compensation laws reports are a great resource to identify the similarities and differences across workers’ compensation systems in U.S. states and Canadian provinces.

Q6: Is WCRI working on any research that will help us better understand the impact of COVID-19 on state workers’ compensation systems?
A6: WCRI has a wealth of studies that provide a pre-COVID baseline for evaluating the impact of the virus on workers’ compensation claims. This includes WCRI’s CompScope Benchmarks studies, which compare a range of workers’ compensation performance metrics across 18 states. In the future, we will evaluate the impact of the virus on the composition of claims and their costs, how the virus may have affected the delivery of care to workers and the impact of that on worker and claims outcomes, including duration of disability.

To learn more about WCRI, visit www.wcrinet.org.