Top WC Researchers Share Latest COVID-19 Data

Nancy Grover

Sarasota, FL (WorkersCompensation.com) – There were 50,592 COVID-19 claims in the California workers’ compensation system as of the end of October. While July saw the most claims, at nearly 16,000, the rate has been falling since. But experts project there could be an uptick in the October figures.

The new figures from the California Workers Compensation Institute were announced during a presentation of workers’ compensation data experts, as part of the Comp Laude Awards & Gala.

Though still immature, the data presented yesterday is a far cry from the attempts to respond to questions early on in the pandemic. As the nation began seeing restrictions and lockdowns, workers’ compensation researchers were under great pressure to determine things such as the potential number of claims and costs to the system.

“Early on there was tension; lots of assertions, about high denial rates, delays in investigations,” said Alex Swedlow, president of CWCI. “It was really just crying out for some grounded, objective data.”

Fast forward, and the organization now has an interactive app that provides information on:

  • 2020 COVID-19 claims
  • 2019 v 2020 claim volume
  • Trends
  • Industry details
  • Notification and denials

The information can be broken down in a variety of ways, such as by region, industry, demographics, injury description, insured vs self-insured. It is available to the public free of charge.

Denial Rates

One issue that has been contentious is the rate of COVID-19 workers’ compensation claims that have been denied. CWCI researchers found that 28 percent of claims were accepted, 37 percent were being reviewed and there was a 35.5 percent denial rate, “significantly higher than the rate for non-COVID claims, about two-and-a-half to three times higher. This was the question: why?” Swedlow said. “Seventy percent was due to a negative COVID test. The balance was due to having contracted the virus outside the workplace, not having a physician’s diagnosis, or refusing to take the COVID test. It all made perfect sense to us.”

While the denial rate in California has been reduced in recent months, it still stands at around 29 percent to 30 percent, or 2.5 times the rate of non-COVID claims.

Denial rates vary greatly among jurisdictions. Research from the International Association of Industrial Boards and Commissions found, for example, that New York and Washington have very low rates of denial. “In Washington, one of the reasons the rate is so low is because they made a policy choice that they were just going to pay exposure claims for the quarantine period,” said Jennifer Wolf, IAIABC’s Executive Director. “Those policy decisions are influencing some of the behaviors we’re seeing across jurisdictions.”

Colorado, on the other hand, has a denial rate for COVID-19 claims of 67 percent, what the IAIABC terms an outlier. “We are not exactly sure what’s driving that,” Wolf said.

Other New Stats

Another subject of discussion has been whether and the degree to which non-COVID claims have been in the system compared to last year. CWCI’s researchers found there were 22 percent fewer claims in its system; however after adjusting for late reporting factors – especially COVID – the organization projects 12 percent fewer claims as of the end of October.

Overall, about 11 percent of the 2020 claims in California’s workers’ compensation system are COVID related. But the picture looks very different, depending on the jurisdiction considered.

A 28-state study of claims for the first two quarters of the year revealed “an incredibly wide range,” said John Ruser, president and CEO of the Workers Compensation Research Institute. At the low end, were South Carolina and Kansas – each with just 1 percent of total claims related to COVID-19; Massachusetts, on the other hand had 42 percent of its claims COVID related, and 59 percent for claims with more than 7 days of lost time.

The WCRI study also showed that most of the 28 states saw a 30 percent decrease in non-COVID-19 claims during the first two quarters. It was “up to 53 percent in New York,” Ruser said. “Employment declines are much small than the declines in claims.” Workers, he said are just not filing as many claims for whatever reason.

Presumption laws are another issue being closely followed by workers’ compensation stakeholders. A question is whether and how they will impact claims handling.

“Massachusetts is not a presumption state, and yet it has the highest percentage of COVID claims,” Ruser said. “They pay without prejudice.”

Currently, about 15 states have presumptions. “Not every presumption is created equally,” Wolf said. “Some, like Pennsylvania’s are extraordinarily narrow; it includes benefits only for state National Guard members.”

The presumption laws also vary in terms of which workers are covered. Utah only provides benefits for first responders.

“It will be interesting because of the unique nature of COVID to see how that presumption impacts or influences how these cases are handled,” Wolf said.

Finally, the cost of COVID-related claims is very much on the minds of the researchers. The vast majority are fairly low cost from a medical perspective. “Some don’t require any medical treatment, just lost wages from that isolation period,” Wolf said. “However a small percentage require hospitalizations and more intensive care. That is definitely something that will continue to mature – what those long term costs will be, especially with hospitalizations. My understanding is often these cases require rehab and these are longer cases to develop.”

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