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Presumption led to increase in health care worker claims: Study

Posted On: Jul. 8, 2020 1:48 PM CST

California COVID

Workers compensation claims related to COVID-19 filed by California health care workers after the state’s presumption order took effect increased by nearly a third, but most claims closed quickly, according to third-party administrator Athens Insurance Service Inc.

Workers comp claims overall jumped 32% in the spring, with health care workers accounting for the highest number of claims, the Concord, California-based claims administrator said.

Athens evaluated its COVID-19 claims between March 19 and May 5 to estimate the impact of California Gov. Gavin Newsom’s executive order that made coverage of COVID-19 in the workers comp system presumptive for 16 classes of workers in the state.

After the May 6 issuance of the executive order, which was retroactive to March 19, Athens saw new claim submissions for injuries during that time period increase 29% among health care industry clients, with 66% of those claims filed by employees who provide direct patient care.

Based on Athens’ data, nearly three-quarters of all COVID-19 claims were filed by patient-facing health care workers. Nearly half of those claims were accepted, 31% were denied — most due to a negative COVID-19 test or the lack of a test result — and about 20% are currently under investigation.

Among all COVID-19 claimants, 2.7% of the cases involved hospitalization, and 0.03% resulted in death. The average cost of COVID-19 claims was $5,500, with an average claim duration of 22 days.

More insurance and workers compensation news on the coronavirus crisis here