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.

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

   

   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.

http://www.alabamaworkerscompblawg.com/blawg-post/alabama-attorney-general-says-vaccination-side-effects-are-covered-by-workers-compensation

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

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.

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