NCCI COVID-19 Article Addresses Compensability (Sort of)
A recent NCCI COVID-19 Article (Coronavirus) caught my eye. I have not seen a rating bureau analyze compensability whatsoever. Why?
NCCI is the acronym for the National Council on Compensation Insurance. They are the rating bureau for approximately 35 states.
NCCI has always been very helpful and professional in my dealings with the organization. This article is not meant to berate their article released today. The NCCI COVID-19 article sparked my memory on these types of very complicated and difficult to adjust claims.
Rating bureaus do not review claims for compensability. That comes from each state’s Workers Comp Commission’s rules and regulations. Check out the NCCI press release here. They concluded that “it depends,” which can be said of any injury in any state.
Personal Sensitivities
Personal Sensitivities and Exposure to the General Public has long been debated in claims offices around the country. A few articles on this very subject has appeared in this blog.
Personal sensitivities caused me to receive more than a few angry calls over the years when, usually, a medical-only claim was not paid under Workers’ Comp due to someone having a personal sensitivity to their environment. Please note this varies from state to state.
If you follow the link in the preceding paragraph, a viral (no pun intended) appeared in this blog in 2018 on personal sensitivities. The dish detergent personal sensitivity claim caused many debates on paying what was a small physician’s office bill or denying it.
Exposure To The General Public
Exposure to the general public refers to determining a claim that involves a disease or condition that the claimant may have been exposed to outside of work. Would the NCCI COVID-19 passage in the article refer to something that an employee contracted outside of work or not performing their job duties?
NCCI may have had it correct when they said: “it depends.” If an employee contracts COVID-19, can it be proven that it occurred while furthering the interests of their respective employer? The decisions by a claims department may grow very complex when trying to find the source of the disease.
Exposure to the general public means the employee was exposed or could have been exposed while out in the general public, and not necessarily due to contracting a disease at work.
If you are interested, the best chart for following the COVID-19 outbreak, not surprisingly, comes from Johns Hopkins University at this link.
Complex Decisions
Workers’ Compensation adjuster jobs were complex enough before having to make a COVID-19 accept/deny decision. I have not seen any carriers produce blanket statements yet.
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