While everyone is getting overloaded with information on COVID-19, a question remains unanswered or overlooked. If a person is infected with the virus while at work and/or due to the work they are performing, can it be considered in a worker’s compensation injury claim?
Generally, for an injury or illness to be classified as work-related, the condition must both “arise out of” and “in the course of” employment. In simpler terms, the condition must have its source in employment and not somewhere else. It should be due to the activities or tasks being at work. For example, a health worker who contracts an illness while taking care of patients, who themselves have been infected by the virus. Other claims that meet certain criteria for exposure will be considered on a case-by-case basis.
Filing a Claim
The Industrial Insurance Act allows for treatment of COVID-19 when work-related activity has been proven as the cause of the exposure of the virus, when the work exposes the employee to a greater likelihood of contracting the illness, when there is a documented or probable work-related exposure, an established employee-employer relationship and when other certain criteria is met.
Before assisting a worker in filing a worker’s compensation claim, the treating provider should ensure the worker meets the following criteria:
- If not for the job, would the worker had been exposed to or contracted the condition?
- Does the job increase the risk or likelihood of contracting the condition due to the type of work (for example, a health care worker or emergency medical service personnel)?
- Can the worker be able to identify a specific event or source of contagion while he or she was working?
If all three criteria are not met, it is not necessary to file a worker’s compensation claim. Though a claim can still be filed if
- Requested by the worker or;
- The provider is not sure if the case meets the criteria
Exposure versus Contraction of COVID-19
Employees exposed to COVID-19 must submit the necessary accident report documents prior to receiving insurance payments for treatment or time-loss benefits. The same holds true if the worker is unable to work during the quarantine period or is ill from the virus.
If an accident report form is submitted, the diagnosis is contraction of the COVID-19 virus and all three criteria under “filing a claim” are satisfied, the claim will be allowed, and the treatment is authorized to proceed.
If a claim is filed for probable exposure and the criteria under “filing a claim” is met, the claim will be allowed only for the quarantine period whether the worker contracted COVID-19 or not.
For an exposure claim to be recognized, it should meet all the criteria and the employee must have been quarantined by a local health officer or physician because of the exposure.
The Center of Disease Control indicates that the symptoms for COVID-19 manifests anywhere from two to 14 days after exposure. Time-loss payments can be allowed for lost wages during period for up to 14 days. Any appropriate medical testing or surveillance can also be covered. Take note that this benefit is time-limited and no benefits will be paid after the quarantine period, unless the worker tests positive for COVID-19.
As a general rule with the wage replacement benefit under the Industrial Insurance Act, the initial three days are not paid unless the employee is medically required to remain off work on the 14th day following exposure.
A careful employer should plan to communicate their commitment to the health and safety of their workers, while encouraging any employee who suspects that they might be infected with COVID-19 though a work exposure, to report the illness so that their rights under the worker’s compensation system will be fully protected. If in doubt, it is wise to consult with a legal team for clarification and determine on the best way to handle the situation.
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