One-quarter of COVID comp medical claims had long-term issues in Texas

Between 23% and 24% of workers with accepted COVID-19 workers compensation claims who received medical or hospital/facility services received these services beyond one month post-injury, according to a report released Monday by the Texas Department of Insurance, Division of Workers’ Compensation.

Using data gathered from 74 insurers in the state, the division also reported that as of Aug. 7, insurers saw more than 90,000 COVID-19 claims and 459 fatalities. Slightly more than half of these claims (51%) and the fatalities (55%) involve first responders and correctional officers.

Sixty-eight percent of claims involved employees who tested positive or were diagnosed with COVID-19 and insurers reportedly accepted 59% of such claims. Insurers denied 39% of COVID-19 positive test claims; and despite more than 22,000 denials of COVID-19 claims with positive tests or diagnoses, there were only 207 disputes filed with DWC as of Aug. 7.

Overall, during the COVID-19 pandemic, 65% of COVID-19 claims filed had indemnity-only payments associated with them, according to the report.

Of the 35% of the medical and indemnity claims, 89% of the hospital/facility payments were made for inpatient services, followed by outpatient services (8%) and other (3%). Nearly one-quarter (23-24%) of claims received these services beyond one month post-injury, while only a small percentage (8-9%) of claims received these services for more than six months post-injury, according to the report.