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Workers Comp COVID-19 Vaccination Claims – Adjusters Confused


Workers Comp COVID-19 Vaccination Claims – Who’s on First?

Today, I decided to check on how Workers Comp COVID-19 vaccination claims are being handled by claims adjusters. Most of the adjusters had some sort of handle on how to investigate and adjust claims that involved COIVI-19.

picture of workers comp COVID-19 vaccination claims
Public Use License – Maximilian Schönherr

The states have now decided to pile on more legislation on approving/denying claims that involve COVID-19 vaccinations. Whew!, the worker’s comp claims adjusters‘ job could not be more complicated with the new rules and with states that have new “emergency rules” in process.

Yesterday, I wrote an article on how more complicated the job of the worker’s comp premium auditors became with the pandemic. Check it out at the link.

Three Adjusters’ Comments on COVID-19 Vaccination Claims

Where did I make the confused claims adjuster assumption?   I called up three adjusters and asked them.  As with yesterday’s article on premium auditors, I have provided anonymity.   The three adjusters are monoline (workers comp only), multistate adjusters.

They all three were working out of their home offices.  I called them after 5 PM as to not disturb their normal work hours.

Their comments were (summarized):

  1. One state that I handle just had new vaccination claim rules, and the other two are still in process.  I knew how to adjuster any COVID-19 claims – now the states are coming up with these new sets of rules that are conflicting.  I am waiting on my carrier to send out a memo on how to handle the vaccination claims.  I hope that email arrives very soon.
  2. If it is a requirement of the workers’ job, my Third Party Administrator has said that we should pay the claims as if it was an on-the-job injury.  If their job did not require the vaccination, that is a grey area.  Most people are working from home now, so why would the vaccine be required unless their company requires it to return to an office environment?  I am a little confused but will handle them on a case-by-case basis.  I hope my TPA provides more direction on these claims soon.
  3. We are denying them unless they are frontline health workers or have a written requirement by their employer to have the vaccination to continue working.  Two of the states I handle have said they are compensable
    Frontliners of COVID-19 Vaccination Claims wearing PPE
    Wikimedia Commons – Javed Anees

    regardless.  I have seen a few articles that have conflicting opinions.

The most common comment was that the states are changing or may alter the rules on COVID-19 vaccination workers comp claims.  The three adjusters were not expecting a high number of vaccination reaction claims.

Checking Out The Articles on COVID19 Vaccination Claims

I listened to a Corvel webinar last week on COVID-19.  One of the presenters had said the same thing as adjuster #2 – it needs to be handled on a case-by-case basis.

An article by the venerable WorkCompCentral – (behind a paywall) – by Mike Fish had an interesting take on the situation from the Alabama Attorney General’s office.   The AG said that if the vaccination was required by an employer, the State of Alabama would likely say this is a covered event under the Workers’ Compensation statutes.

Update – Mike FishAttorney for Fish, Nelson, and Holden said sent me a nice note in the comments that referred me to the free article (not behind a paywall).  The article can be found at this link.


What Do The Rating Bureaus Say – NCCI Has A Huge Reference Guide

Attorneys says COVID-19 Vaccination Claims has side effects
Wikimedia Commons – The United States Department of Justice

I checked out this page to see if there was any information on COVID-19 vaccination claims.  I could not find any current legislation that had already been enacted on vaccination claims.   It could be that the legislation is still in progress or that it was contained in the prior COVID-19 legislation.

There was nothing on the WCIRB website.  While I was finishing up the article, WCRI sent over a press release on the early effects of COVID-19 claims.  You can check out the study that covered COVID-19 claims in 27 states here. 

Compensable Workers Comp COVID-19 Vaccination Claim?

This nurse passed out and then disappeared from the hospital where she worked in Tennessee.  I felt bad for her.  Would this be a compensable claim?

The bottom line is the worker’s comp adjusters and premium auditors’ job may have been made much more complicated by enacting rules that were actually already covered by worker’s comp occupational disease rules.

©J&L Risk Management Inc Copyright Notice


2 Responses

  1. My apologies Mike, I thought you were a writer for WC-Central. I will post an update to the article today that includes the link to the free article. Thanks for reading the blog. I will sign up for your blog (blawg) today. Have a good Friday and be safe.


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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