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.
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.
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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
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?
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]
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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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