Morgan’s Tip of the Week – Investigating COVID Claims

Greetings, hope everyone is well and staying sane.

I am receiving several daily questions about compensability of COVID-19 claims under 440.151 Occupational Disease.   A point to remember, unless someone actual has contracted the virus, there is no “injury” and therefore no claim.  And even after, it then needs to be evaluated as to whether or not the claim meets the definition of an Occupational Disease for that individual claimant.

The question that has come up involves whether a 120 day letter should be sent when a potential claimant has been in contact with someone with COVID-19 and is awaiting testing or test results.   I do not think so, and it could cause major issues if the letter is sent at that point.

Under 440.192, a carrier has 3 choices when a claim is received: pay, deny or pay and investigate under the 120 day rule.   If the 120 day rule pay and investigate is elected, that means you must pay for everything until you actually deny or accept it.   In this current situation, that will likely be indemnity while the person is quarantined.  And it could turn out they don’t have the disease.   Additionally, should a claimant be hospitalized or pass away before you make the decision whether it qualifies as an occupational disease, you would have to pay for all of those costs, arguably including death benefits.  

Another question I have been getting is about the $1,200 stimulus checks, and whether that is earnings for TPD offsets, IB calculations or other benefits.   My take, it is not income.  Its not taxed for Federal income tax purposes, and I don’t believe there is any offset or impact on WC benefits.

Morgan  Indek | Managing Partner