Oregon proposes guidance on COVID-19 claims

Insurers would have to conduct a “reasonable investigation” before denying a workers compensation claim related to exposure to COVID-19 on the job and report to state regulators when it has five or more such claims filed, according to a proposal made public Wednesday by the Oregon Department of Consumer and Business Services, Workers’ Compensation Division.

The Management-Labor Advisory Committee’s proposed rule, of which it is now seeking public comment until Monday, would apply to all claims filed on or after Oct. 1.

According to the proposal, an investigation must include at a minimum determinations “whether the nature of the worker’s employment resulted in an exposure to COVID-19 or SARS-CoV-2” and “whether the worker did not work for a period of quarantine or otherwise at the direction of a medical service provider or public health professional, or the employer.” In addition, “before the insurer denies the claim, the worker tests positive for COVID-19 or is given a presumptive diagnosis of COVID-19, the insurer is aware of the test results or diagnosis and the source of the exposure is unknown, the insurer must obtain a medical opinion before issuing a denial.”

An insurer with five or more claims will be subject to an audit to investigate compliance with proposed rules, according to the proposal.

More insurance and workers compensation news on the coronavirus crisis here.