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Texas report shows most COVID-19 comp claims denied


Of the 12,305 COVID-19 workers compensation claims filed by workers in Texas since a statewide disaster was declared on March 13, only 35% included claimants who tested positive for the virus and 38% of those were denied, according to a report released Tuesday by the Texas Department of Workers’ Compensation.

The data, collected from 66 selected insurance carriers, showed that claim activity in Texas from January to August was about 22% higher than in the same period in 2019.

Insurance carriers accepted 48% of COVID-19 positive test claims, and 14% are still being investigated, according to the report. Despite more than 1,633 denials of COVID-19 claims with positive tests or diagnoses, there were only five disputes filed with DWC as of Sept. 27, the report states.

Using DWC’s administrative data as of Oct. 8, insurers and employers paid $13 million as indemnity benefits on COVID-19 claims, with $10.5 million in employer salary benefits, $2.5 million toward workers comp income benefits, and $13,965 in death benefits.

Using that same data, the DWC found that insurers paid a total of $4.4 million in medical costs on COVID-19 claims. Most — 86% — of these payments were for hospital/facility services, including COVID-19 testing, while 13% went to professional fees and 1% to pharmacy costs.

More insurance and workers compensation news on the coronavirus crisis here