Report: Hospital System Leads State in COVID-19 Claim Denials

Thursday, December 10, 2020 | 0

Providence Health & Services, the largest hospital group in Oregon, denied a disproportionate number of medical-only comp claims for COVID-19, according to a report by Willamette Week.

Providence, which is self-insured, has denied 90 non-disabling claims related to the pandemic this year, the alternative weekly reported. The hospital group’s denials reportedly account for 44% of the 205 claims that were denied through Nov. 30.

State-chartered SAIF Corp. denied 40 claims; Church Mutual Insurance Co. denied 18 claims; Liberty Mutual Insurance Corp. denied seven claims; and 49 other carriers combined to deny 50 claims.

The Oregon Nurses Association accused Providence of failing to protect frontline providers.

A spokesman for the hospital said 89 out of 90 claims were denied because the claimant didn’t test positive. The claimant who tested positive was exposed to the virus outside of work, the spokesman said.

Oregon House Speaker Tina Kotek, D-Portland, reportedly plans to introduce legislation that would create a presumption that COVID-19 is compensable “for workers who are essential to a sustained economic recovery,” according to a spokesman.

Temporary regulations in effect through March 29, 2021, require audits of carriers and self-insured employers that reported five or more claims for COVID-19, regardless of whether those claims were accepted. The audits are intended to ensure payers are conducting a reasonable investigation to determine whether the nature of employment resulted in exposure to the coronavirus.

The Workers’ Compensation Division is holding a public hearing Jan. 5 to accept testimony on a proposal to make the rules permanent.