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NCCI COVID-19 Article And Claims Compensability Debate


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 COVID-19 Rotovirus simulation
Rotavirus – Public Use License – Graham Beards

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

Blowing NCCI COVID-19 woman nose

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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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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