Synopsis: WC/OD Coverage Considerations and Compensability for Covid-19 Claims. Learn what “I.I.I.” or “Infectious Incident Investigation” Means.

Editor’s comment: As I have advised my readers, consider anyone investigating the “incident” leading to determination of when/if someone got Covid-19 at work to be just that—an incident you have a duty to fully investigate. You need to make it clear to your workers they need to fully cooperate as lives are clearly at stake. The focus isn’t on a WC-only claim—you are investigating a possible occupational disease that is primarily contracted from contact/germs from other humans. See my article below for investigation tools/questions to best investigate and track Covid-19 exposures.

In general, an illness that arises from Covid-19 will need to meet both to be compensable and result in WC/OD benefit eligibility:

Illness/exposure must arise out of and occur in the scope of employ.
Illness must arise out of or be caused by conditions particular to the work and not an ordinary disease of life to which the general public is exposed.

In the case of Covid-19, it is critical to understand the job an employee was performing if/when exposed.

Legal, claims and insurance experts are aware of the recent activity in many states involving executive orders and legislative activity. For example, healthcare professionals, first responders (EMT), hospital workers, and lab technicians often have a lower threshold for connecting the cause/source to the course and scope of their work.

OSHA is now mandating you investigate and report positive diagnoses for Covid-19. If you have concerns about how to handle an OSHA issue, reach out to KCB&A’s top OSHA attorney, Brad Smith at bsmith@keefe-law.com for great advice.

WC/OD Claim Reporting and Management

In accordance with state WC/OD requirements, employees or managers who think they or their colleagues could have a COVID-19 work-related claim that meets the threshold for compensability, as outlined above, should seek prompt reporting and investigate it immediately. Convey this urgency to report and investigate to your entire workforce as often as possible. This will allow your workers compensation/occdisease legal/claims and risk experts to work with you and your employee to determine if benefits are appropriately due.

As the infection continues to spread across the U.S., establishing place of work as the sole source of exposure, rather than exposure by the general public, will become increasingly challenging. Each claim will be considered as unique with individual merits.

When you investigate a suspected Covid-19 related WC incident, please:

Mention Covid-19 in the incident description to allow legal, claims and risk managers to recognize the need to mobilize.
Determine if the worker had contact with a person known to be infected with or treated for Covid-19. This is called “contact-tracing.”
If so, include when and where that contact occurred.
As part of the infectious incident investigation confirm when symptoms of Covid-19 began, and if the diagnosis was confirmed.
Inquire to confirm whether the worker, or any member of their immediate family or household, recently travelled to any high-risk areas.
Determine if immediate family members are currently showing similar symptoms.
Ask what other employees the worker may have had close contact with recently.
Share any information related to perceived higher risk of exposure for this specific employee and the nature of that exposure (e.g., healthcare worker or first responder).

Operational response plan for employers

The best way to contain potential exposures to Covid-19 during this period is to focus on employee well-being and safety. You should also review your group health plan for potential coverage for preventative care.

Does workers compensation/occdisease coverage typically cover employees traveling abroad?

IL WC/OD and many state acts extend WC/OD coverage for foreign travel. Consider virtual travel until the pandemic ends.

I appreciate your thoughts and comments. Please post them on our award-winning blog.

Synopsis: Infectious Incident Investigation into Covid-19 WC/OD Claims.

Editor’s comment: Our clients and my readers have been asking for guidance on investigating potential COVID-19 claims. Please remember when you are looking into Covid-19 potential claims, you aren’t typically investigating an “accident.” This is a disease investigation.

Health Privacy Laws in a Work-Related Infectious Incident Investigation

Please note having the worker sign a HIPAA-compliant release form will protect you. Ask them to do so and save it to their medical file—don’t put it in their personnel file. Don’t put any of the investigation into their personnel file. If you need a HIPAA-complaint release, send a reply and I will forward it immediately. If the worker refuses to sign, you can still move forward and ask everything I outline below. If you aren’t sure how HIPAA works in this milieu, send a reply.

My advice to everyone is get the word “accident” out of your lexicon—“incident” works better. “Infectious Incident Investigation” works even better!!

If you have and will investigate WC/OD claims for the Covid-19 disease, here is Gene Keefe’s infectious incident investigation protocol

QUESTIONS FOR WORKERS IN AN INFECTIOUS INCIDENT INVESTIGATION.

1. What is your job title?

2. What are your job duties?

3. What are the specific job duties that you claim led to the infectious incident exposure?

Get specifics and find out how often the job duties outlined might put your employee in connection with the virus.
Consider second level investigation when you have that information.

4. When did this alleged infectious exposure take place?

5. How many times where you exposed?

6. How long were you exposed each time?

7. If the exposure is claimed related to interaction with a person at work – who do you allege had the diagnosis of Covid-19 disease and what work-related connection do you have to that person?

8. How often did you come into contact with this person.

9. When and where do you come into contact?

10. What was the nature of your contacts with this person?

11. What exactly were you doing when you allege you were exposed to this virus from that other worker or workers?

12. Do you know anyone outside of work who has been sick with any medical condition(s) recently?

13. If so what is you connection and exposure to them?

14.Do you know anyone who has been positively diagnosed with Covid-19 disease?

15. If so who and what if your connection to that person?

16. Have you traveled outside of the United States for any reason in the last month? If so where were you?

17. Do you know anyone who has traveled outside the United States in the last month?

18. If so who and what is your connection to that person?

19. Do you have another job? If so, explain.

20. Do you have any hobbies or social activities that might expose you to Covid-19 disease?

A. IF EMPLOYEE IS ALLEGING EXPOSURE ONLY

All the above questions above, and

Describe all of your work locations for our company for the past 30 days.
Were you properly using any employer-provide PPE or personal protective equipment?
Have you been tested for Covid-19 disease?
What were the results?
If you haven’t been tested, do you plan to be tested for Covid-19 disease?
If so, when and where?
Has anyone you know outside of work tested positive for COVID-19?
If so, when and where?
Are you being treated for Covid-19?
Have you taken any medication related to this alleged exposure?
Has anyone else at your work site(s) told you they were exposed?
Has anyone at your work site(s) told you they were positive for Covid-19?

B. IF ALLEGING POTENTIAL ILLNESS/INFECTION

These additional questions apply to a claimant who is alleging exposure and illness, but has not received a formal diagnosis (positive COVID-19 test).

All of the above questions, and all questions regarding alleged exposure and

Do you have a fever?
Have you had a fever? If so, when?
Describe your current and continuing symptoms.
When was the onset of your current symptoms?
Do you have any other unrelated medical conditions?

Are you on any medications?

C. IF ALLEGING CURRENT COVID-19 ILLNESS

These questions apply where the claimant has a positive COVID-19 test result. Ask all the questions above and

Where was your positive diagnosis made?
By whom?
What treatment was provided at the time of diagnosis?
What guidance did the testing provider give?
When (time and date) was your diagnosis made?
How long did you have symptom onset before testing and diagnosis?
When was the last day you worked prior to your positive test?
Have you been ordered to self-quarantine by any health or civil authority?
How long have you been in isolation?
Who do you live with; inquire about family members affected.

QUESTIONS FOR SUPERVISORS

Here are questions for risk/claims managers when asking supervisors and onsite managers

A. “SUSPECTED BUT UNCONFIRMED” STATUS

This inquiry includes employees who self-report they have symptoms, employees who self-report they came in contact with someone with presumptive positive case of COVID-19.

Did you send employees home from work who were showing symptoms? If yes, explain.
Did you send employees home from work who self-reported contact with presumptively positive person?
Did you observe and record employees with symptoms?
Did you take employee’s temperatures?
What precautions did you take for those collecting temperatures from employees, applicants, or customers?
Was Personal Protection Equipment (“PPE”) distributed to employees? If so, what PPE was made available?
Were any employees traveling into an known-affected area? Any employee traveling to and from a non-restricted area? If so, where?
Were any employees traveling from a Covid-affected area?
Were any employees traveling through any of the 13 airports where DHS has established enhanced screening procedures in the last 90 days? What was the result of their medical interview (if known).
Has a remote work policy been implemented? If so, when?
Did you send home all employee who worked closely with the presumptively positive individual?
How many employees did you send home?
Did you remain in contact with employees sent home to determine if they developed symptoms?
How long did employees remain in self-isolation?

B. CONFIRMED POSITIVE / EMPLOYEE TESTED POSITIVE

These questions are for employers with confirmed (“tested”) positive claimants.

Did employees test positive?
What was your protocol for positive employees?
Did you remain in contact with infected employees to determines status?
Was any report made to CDC, OSH, State OSH, State DOL, or local health authorities?
Did you send home all employee who worked closely with the positive individual?
How many employees did you send home?
Did you remain in contact with employees sent home to determine if they developed symptoms?

I appreciate your thoughts and comments. Please post them on our award-winning blog.

Synopsis: Indiana Worker’s Compensation/GL News: TTD and PPI Rates Stay the Same, but Mileage Reimbursement Goes Up, and PPI calculations for Extremities Are Being Changed.

This is a “Must Read.” Comment by Kevin Boyle of Keefe Campbell Biery & Associates, LLC.

Editor’s comment: Every year about this time, the new Indiana statutes go into effect on July 1. Also as usual, many WC changes to the statutes were proposed during the Legislature Session, but few actually made it into law. Here is a summary of a few important changes you should know about.

First, although it was proposed and expected, the TTD minimum/maximum rates and PPI rates did not change. Please keep using the same rates that you have used for injuries that occur after 7/1/2016.

Second, the IWCB’s mileage reimbursement rates slightly increased from .38/mile to .39/mile for travel outside the county of employment on or after March 1, 2020. This change is not statutory, but was enacted by the State of Indiana Department of Administration that must be followed by the IWCB per I.C. 22-3-3-4.

Third, there were some statutory changes to the PPI statute (I.C. 22-3-3-10) for vision claims. Subsection (i)(12) was deleted and a new one was substituted: “Visual impairments shall be based on the Functional Vision Score (FVS), assessing the visual acuity and visual field to evaluate any reduction in ability to perform vision-related Activities of Daily Living (ADL). Unless such loss is otherwise specified in subsection (i)(5), visual impairments shall be paid as a whole person rating.”

Finally, although the PPI rates were not changed, the IWCB has instituted Guidelines that will affect PPI calculations for upper and lower extremities from now on. You may have had 1043s recently rejected even though your PPI calculations were based on the same PPI chart we’ve used for decades. If you’d like a copy of these new guidelines, or an updated rate chart, let me know. In summary, a wrist injury will be considered an impairment of the upper extremity, but if use of the hand is also affected, there should be a hand rating as well, and these will be combined. Also, if there are impairments to various parts of a limb, such as an elbow and wrist, the Board will approve payment for the combined rating to the upper extremity.

Also, upper and lower extremity impairments will no longer be separated into above or below the joint except in the case of amputations, per IC 22-3-3-10 (i)(1), (9) and (10). Upper extremity ratings for those joints should be based on 50 degrees, not 40; lower extremity ratings for foot, ankle (and knees) will be based on 45 degrees instead of 35 degrees. These PPI changes are advisory, for general guidance, and not enacted by a new 2020 statute, but these changes are being implement and enforced by the IWCB in approvals and calculations now.

Stay tuned for more. If you have questions/concerns about Indiana worker’s comp, general liability, MVA, employment or any other legal issues, please contact: kboyle@keefe-law.com

Synopsis: Join KCBA’s very own Brad Smith, J.D. for his podcast discussing all trending legal topics.

Editor’s comment: In Brad’s Everything Legal Podcast, Brad discusses the legal world in an understandable and practical way. In his initial episode Brad analyzes the legislation that matters to you and other notable circumstances surrounding the COVID-19 Pandemic. Brad’s podcast will continue to explore legal topics of significance on an ongoing basis. We hope you can subscribe and happy listening to you.

Please subscribe on Apple Podcasts, Spotify, or Anchor by searching “Brad’s Everything Legal Podcast.”

You can also link to the Apple Podcast here: Brad's Everything Legal Podcast.

Synopsis: The “Nuts and Bolts” of Investigating OccDisease Claims with a Specific Focus on this Pandemic and New Rules Mentioned Above—Consider Asking Shawn R. Biery, J.D. for His OccDisease Investigation Protocol.

Editor’s Comment: Shawn R. Biery of Keefe, Campbell, Biery & Assoc understands the challenges this crisis has brought to you and your claims management protocols. Suddenly, we are all being asked to figure out when/where and how someone contracted a life-threatening disease which comes with possible 7-figure OD claims exposure. To understand the risks and costs, please remember Shawn regularly updates his Illinois WC Rate Sheet—if you want a copy, send an email to Shawn or his great assistant Marissa Patel at mpatel@keefe-law.com

What Shawn has begun to detail are crucial investigation materials which you might want to consider--his new OccDisease Investigation protocol to allow you to:

Investigate and verify OccDisease claims for emergency workers covered under the new Rules promulgated by the IWCC;
Investigate and verify claims for other workers possibly not covered by the Rules and
Insure you have a strong basis to accept or deny OccDisease benefits in settings that may come at you and your company very rapidly.

We are constantly working to update the potential investigation protocols. Please again note, as we outline above, any Covid-19 exposure may come with 7-figure risk/reserves on a per claim basis—this is possibly a business-busting concept.

Please also make note, if you don’t diligently investigate, even without a presumption, our IL WC Commission may rule any Covid-19 claim is going to be adjudicated to be compensable.

Those supervisors, managers and adjusters who are now becoming OccDisease investigators will need the following skills:

Interviewing – the ability to draw out the relevant information through effective questioning

Communication (verbal and written) – the ability to interact effectively with injured persons, witnesses and suspects, as well as other investigators, and to communicate the findings of the investigation to a wide variety of individuals and organizations

Technical competence – the awareness of safe working procedures that should be adopted, with particular relevance to the event under investigation

Hazard recognition – the ability to ensure workers and investigators are not exposed to unnecessary risk

Interaction – personal attributes that enable effective relations with other people

Deduction – the ability to scrutinize all the evidence obtained, e.g. through observation, from witnesses’ statements and from documentary evidence, and to form a coherent picture that enables the causal factors to be identified

If you want a copy or someone to consult with an OccDisease Investigations and Rules, feel free to contact Shawn at sbiery@keefe-law.com or John Campbell at jcampbell@keefe-law.com

KCBA Blog

6-16-2020; Infectious Incident Investigation into Covid-19 Claims and more