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COVID-19 Vaccination Reaction Claims- Compensable In Texas?

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Texas Says Report COVID-19 Vaccination Reaction Claims (Work-Related)

In reading various Workers Comp publications – yes, I do that in the evenings, I came across an article in Business Insurance Work Comp News that caught my eye.   The Texas Department of Insurance released a memo on March 2, 2021, that employers should report any COVID-19 vaccination reaction claims to their carrier/TPA by filling out a report of injury.

pic of smallpox COVID-19 Vaccination Claims vial needle
(c) Public Domain – CDC

That request piqued my interest enough to cause me to research the memo so that any of our clients or really any employer could have this advice.  I had written a few articles on Coronavirus vaccine concerns in the last few months.

TDI Says Not All COVID-19 Reaction Claims

The one area that could leave things up in the air would be “if the reaction was due to an employer-required vaccine.”  That statement may cover more ground than one might think – employer required?

The link to the PDF from the TDI can be found here, or the memo can be found below converted from PDF to HTML.  Sometimes the PDFs will be moved by the authors and then poof! you receive a 404 error.

The TDI was kind enough to supply an email address for any questions.

_____________________________________

To: Texas Workers’ Compensation System Participants
From: Joseph McElrath, Deputy Commissioner, Business Process
Date: March 2, 2021

Re: Reporting COVID-19 and COVID-19 Vaccine Reaction Claims

Texas Flag COVID-19 Vaccination Reaction Claims raising
Public Domains – Makaristos

The Texas Department of Insurance, Division of Workers’ Compensation (DWC) provides the following guidance to insurance carriers when submitting a First Report of Injury to DWC using electronic data interchange (EDI) for COVID-19 or a reaction to the COVID-19 vaccine.

How should I report a COVID-19 First Report of Injury to DWC?

On March 27, 2020, DWC published guidance advising insurance carriers to submit a COVID-19 First Report of Injury using the International Association of Industrial Accident Boards and Commissions’ (IAIABC) codes for EDI claims reports: “cause of injury” code 83 – Pandemic and “nature of injury” code 83 – COVID-19.

DWC reminds insurance carriers to use these specific codes when reporting a First Report of Injury involving a COVID-19 exposure or infection. Insurance carriers should also clearly indicate whether the claim involves COVID-19 in the incident description field. Following this guidance allows DWC to accurately monitor the frequency, cost, and outcome of
these reported claims.

Should I file a First Report of Injury with DWC if an employee has an adverse reaction to a COVID-19 vaccine?

If a COVID-19 vaccination relates to an employee’s job, and it causes the employee to miss one or more days of work, you should file a First Report of Injury with DWC. Submitting a First Report of Injury to DWC does not mean that a COVID-19 vaccine reaction is work-related or that the insurance carrier is liable for payment.

How should I report a First Report of Injury to DWC that involves an adverse reaction to a COVID-19 vaccine?

Moderna COVID-19 Vaccination Reaction Claims portrait
Public Domain – Airman 1st Class Anna Nolte

The IAIABC and the Workers’ Compensation Insurance Organizations (WCIO) have developed new coding guidance for reporting an adverse reaction to a COVID-19 vaccine.

Insurance carriers should report COVID-19 vaccine reaction claims using the new “nature of injury” code 38 – Adverse Reaction to a Vaccination or Inoculation combined with the “cause of injury” code 83 – Pandemic. Insurance carriers should also clearly indicate whether the claim involves a COVID-19 vaccine reaction in the incident description field
by using language such as “COVID-19 vaccine reaction.” Do not report vaccine reaction claims using “nature of injury” code 83 – COVID-19.

Questions?

Insurance carriers should contact their trading partners to discuss claim EDI reporting requirements. For questions, contact Martha Luevano at 512-804-4858 or [email protected]

____________________________

If you have a working relationship with your carrier or TPA, then they have likely addressed this issue with you in the past.   You do have a working relationship – right?  If not, start working on that today.

Other states may have the same language built into reporting COVID-19 vaccination reaction claims advisories.

 

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt 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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