NLA’s Coronavirus Response and Claim Handling Procedures

NLA is carefully monitoring the situation with COVID-19. The safety and wellness of our employees and clients is our highest priority. As of right now, we are continuing with business as usual to be there for our clients at a time when they may need us the most.

We recommend our clients stay up to date on the CDC’s guidelines for businesses and employers to plan, prepare and respond to COVID-19 (please refer to the CDC for additional guidance related to the below):

  • Actively encourage sick employees to stay home.

  • Separate sick employees.

  • Emphasize staying home when sick, respiratory etiquette and hand hygiene by all employees.

  • Perform routine environmental cleaning.

  • Advise employees before traveling to take certain steps.

Additional measures we are taking:

  • Employees who are well but who have a sick family member at home with COVID-19 should notify their supervisor and refer to CDC guidance for how to conduct a risk assessment of their potential exposure.

  • If an employee is confirmed to have COVID-19, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA). Employees exposed to a co-worker with confirmed COVID-19 should refer to CDC guidance for how to conduct a risk assessment of their potential exposure.

As for our employees, we have the ability to allow the majority of our team to work from home and business can continue as usual.

Workers’ compensation claims

So far, NLA has received a handful of claims of coronavirus cases. As coronavirus claims continue to grow in the United States, we have been getting many questions on whether people who are diagnosed with COVID-19 would be covered under a workers’ compensation policy. We will evaluate each claim on a case-by-case basis, and we are looking at the following general guidelines to determine if the claim is compensable. Ask yourself, did the disease:

  • Arise out of and in the course of employment,

  • Be proven to be the result of a workplace exposure, and

  • Arise due to employment that places the employee at a substantially greater risk of contracting the disease or condition than the risk experienced by the general public.

Compensability will come down to:

  • The facts of the actual claim.

  • The workers’ compensation statutes and case law of the state the claim has been filed in.

  • Further direction from a political entity or state/federal guidelines.

Investigation of Coronavirus Claims

All Covid-19 claims that are established will be identified on the Claim Detail page under the Tag field with “Corona” listed as the code. The Director of Compliance will be reporting weekly to United Wisconsin and daily to Everest, and any other carriers upon request.

Compensability determinations for each case must be determined based on the facts established during a good-faith investigation and the law of jurisdiction. All COVID-19 claims should be assigned to counsel in the appropriate jurisdiction for guidance in statutory requirements. In addition to application of all NLA Best Practice requirements and any state-specific statute or case law regarding occupational disease claims, the following questions and issues are recommended.

For employer contact:

  • Determine the employer’s position regarding compensability of the coronavirus. Many of our clients have developed internal policies that should be considered during the investigation of each claim.

  • Is the employer paying salary for the voluntary quarantine of employees possibly exposed?

  • Does the employer have Foreign Workers’ Compensation coverage? Some employers that have employees that travel outside the U.S. purchase Foreign Voluntary Workers’ Compensation Coverage (FVWC). FVWC covers lost wages and medical benefits, but can also cover such items as endemic disease, 24-hour coverage, and repatriation expense. It is important to know if this coverage exists for the claim.

  • Determine how the claimant allegedly came into contact with a person infected with the coronavirus. How many other employees may have been exposed? What are the circumstances involved in the alleged contact?

  • Does the employer provide any personal protective equipment to its employees? This would include gloves, respirators, masks, and other safeguards to protect employees from contracting communicable diseases such as the coronavirus.

  • Does the employer provide any training to prevent the spread of this and other diseases?

For claimant contact:

  • Did the claimant have any contact with a person known to be infected with the coronavirus? If so, how, with whom, and when and where did the contact occur?

  • When did the person first exhibit symptoms of the coronavirus?

  • Has the claimant been diagnosed with coronavirus?

  • Has the claimant or any member of their family recently travelled? If so, when and why?

  • Are immediate family members currently experiencing symptoms?

  • If the reported claim involves a claimant in a high-risk employment situation, determine the frequency of contact with suspected or confirmed persons infected with the coronavirus.

  • If the claimant had frequent or close contact with patients suspected or confirmed to have the coronavirus, was personal protective equipment provided by the employer and used by the claimant?

  • If the claimant was wearing personal protective equipment, were they provided with specific training for proper use, removal and disposal?

For physician contact:

  • What symptoms and history were initially reported by the claimant?

  • Were the proper tests performed to identify a definitive diagnosis? If so, what tests were performed, and what symptoms led to the tests being performed?

  • From review of the claimant history, was the claimant exposed to the coronavirus at work?

  • Within a reasonable degree of medical certainty, did the condition arise in and out of the scope of employment?

If the reported claim involves a claimant quarantined due to possible contact with the coronavirus, but that person has no symptoms or diagnosis, the workers’ compensation claim is likely not compensable. The reason for this is the requirement that the condition arise out of and in the course of employment has not been met. However, each claim will be evaluated on a case-by-case basis.

Once the claims handler has completed the investigation (including the statement of the claimant), and reviewed applicable statutes and case law, if compensability is still undetermined, the adjuster and supervisor should discuss the claim up the chain of command to include the account manager, employer and carrier.

As indicated earlier, NLA has already had a handful of coronavirus claims reported. It is important that everyone understand what to do if a coronavirus claim is reported, how to handle it, and who needs to be informed.

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