Workers infected with COVID at work might have a claim for workers’ compensation under California law.
California Workers’ Compensation Law
California Workers’ Compensation Law is a no-fault insurance system to compensate workers injured on the job. No fault means that a claimant does not have to prove the employer was at fault. However, the employer or their insurance company can deny a claim because the injury did not occur on the job.
The Division of Workers’ Compensation (DWC) of the California Department of Industrial Relations manages the system. You may file your appeals with the Division.
The statute defines and limits the benefits. Generally, the benefits allowed include:
- Medical care
- Temporary disability benefits
- Permanent disability benefits
- Supplemental job displacement benefit.
- Disability benefits.
Workers’ Compensation for Illness
Normally, companies pay workers compensation benefits in the event of an injury on the job. However, a worker can recover under the California Workers’ Compensation system if they contract an illness on the job or as a direct result of the job.
However, unlike injuries on the job, the necessary linkage between an illness and the workplace is harder to prove. Occupational illnesses are most likely to be linked to the workplace. Work conditions as causes of occupational illnesses such as black lung disease (coal mines) and asbestosis (asbestos exposure). In those cases, exposure away from work is highly unlikely.
COVID 19 and Workers Compensation
COVID 19 is an airborne virus. It often originates in dense gatherings where virus transmission occurs through coughing, loud yelling, or other social conditions. Contrary to early assumptions, transmission rarely occurs through touch.
It can be spread in the workplace as well as anywhere. We are a mobile society. Tracing the origin of a particular infection is difficult under any circumstance. Therefore, a workers’ compensation claim for a COVID illness is problematic.
Don’t confuse fault or liability with the necessary link to the workplace. Workers’ compensation is a no-fault insurance system. But the accident or illness must have occurred at or directly connected to the workplace in the ordinary course of the workers’ assigned duties.
During the COVID pandemic, avoiding transmission meant following protective measures such as masks and human distancing in crowds like concerts, restaurants, supermarkets, movie theaters, and the workplace.
Among those workers most likely to contract COVID are healthcare workers, first responders, police, and firefighters. In September 2020, the California legislature enacted SB 1159, which codified previous Executive Orders that created a rebuttable presumption. That is, an employee’s illness related to coronavirus is an occupational injury and therefore eligible for workers’ compensation benefits if specified criteria are met.
A rebuttable presumption favors the infected worker, but the employer can rebut the presumption by proving that the illness did not originate at work.
The presumption covers first responders, healthcare workers, farmworkers, grocery store workers, and others. The intent was to cover the employee category regarded as essential to sustaining public health and commerce.
Outbreaks in the Workplace
California enacted an additional qualification, unlike other states providing a presumption. It also covers any employee whose employer has five or more employees who test positive for COVID-19 during an “outbreak” at their workplace. For this purpose, the statute defines an outbreak very specifically and numerically.
An outbreak exists if, within 14 days, one of the following occurs at the claimant’s workplace:
- The employer has 100 or fewer employees, and four employees test positive.
- The employer has more than 100 employees, and four percent (4%) of them test positive.
- Closure of the place of employment by the public health department or school superintendent for the risk of COVID infection.
If a California worker within a specified category is infected with COVID-19, it is presumed that they contracted the virus at their workplace and are eligible for workers’ compensation benefits. However, the employer (or the employer’s workers’ compensation insurance company) can rebut the presumption with evidence that the worker did not receive infection at the workplace.
If a worker’s claim is denied because the presumption is rebutted, the dispute is settled by the Workers’ Compensation Appeals Board. Compliance is subject to review by the Division of Workers’ Compensation Audit Unit. Also, the Labor Commissioner’s Office investigates failure to comply with reporting requirements.
Incidence of COVID19 Related Workers Compensation Claims
California, like other states, has seen an annual surge in COVID cases in January and February. January 2022 was extraordinary, with a peak 7-day average of new cases at 109,000.
California Workers’ Compensation claims for COVID-19 illness increased correspondingly, albeit with a reporting lag time. With 2,524 COVID claims, April saw an 83% monthly increase from March. May, with 7,911 claims, saw a 182% increase.
Statistics show that COVID-19 illness accounted for 17.3% of all workers’ compensation claims since the pandemic started. 269,756 COVID-19 claims have been filed since March 2020.
Even though COVID claims have been trending upward, they remain below the January 2022 peak of 55,246 COVID claims.
Potential Workers’ Compensation Benefits for COVID
The workers’ comp benefits paid for on-the-job infection of COVID-19 usually focus on temporary disability benefits for missed work time during quarantine. However, medical costs will include medications, physician costs, and hospitalization.
Some people who suffer from COVID-19 experience long-term effects known as post-COVID conditions (PCC) or long COVID. Post-COVID conditions can carry on for weeks, months, or even years.
Temporary disability benefits are a substitute for lost wages for the time during which an employee cannot work because of COVID. The weekly payment is 60 to 70 percent of your wages 5 to 18 months before your claim. Payments are limited to 104 weeks.
Conclusion
California has adopted an enlightened policy concerning the pandemic in the workplace. It was previously problematic to link COVID infection to workplace conditions. The new law presumes COVID to be work-related for healthcare workers, first responders, and other essential workers. The presumptions are extended to workers in places having a high incidence of COVID.
