CalMatters: Roughly 1 in 5 COVID Claims Denied

Friday, June 5, 2020 | 0

CalMatters reported Thursday that roughly one in five of the more than 5,000 workers’ compensation claims filed between January and May were denied.

The denial rate is lower than what the California Workers’ Compensation Institute reported in May. CWCI reviewed 1,077 claims that were filed as of April 30 and found 35.5% were denied. CWCI said 27.7% of COVID-19 claims it reviewed were approved and 36.9% were pending.

CalMatters reviewed a later set of claims and found the denial rate was lower. Based on data provided by the Department of Industrial Relations, CalMatters reports 1,076 of the 5,093 claims for COVID-19 were denied, for an overall denial rate of 21.1%.

The data does not appear to show how many claims were accepted or how many were pending. And CalMatters doesn’t have a description of why claims were denied.

CWCI, meanwhile, reported that 69.7% of denied claims it reviewed were denied because the worker tested negative for COVID-19. Another 14.5% of claims were denied because there was no proof the person was exposed at work. And 15.8% of claims were denied for other reasons including no diagnosis, lack of symptoms, the person was working from home at the time or the worker refused to take a COVID-19 test, according to CWCI.

Gov. Gavin Newsom issued an executive order in May creating a presumption that COVID-19 is compensable for people exposed to the new coronavirus at work on or after March 19. The governor’s presumption will be in effect until July 5.

Meanwhile, California lawmakers appear to have settled on SB 1159 as the vehicle to create a statutory presumption. The bill by Sen. Jerry Hill, D-San Mateo, would create a rebuttable presumption for “critical workers,” who are defined to include people working “to combat the spread of COVID-19.”

The Senate Committee on Labor, Public Employment and Retirement has not scheduled a hearing on two other bills proposing conclusive presumptions.

The Senate committee, which is chaired by Hill, voted 3-1 to pass SB 1159 on May 14. The Senate Appropriations Committee is scheduled to hear testimony on potential costs of the rebuttable presumption bill during a June 9 hearing.

The Senate Appropriations Committee was scheduled to hear the bill June 1, but the Capitol was closed that day as a result of protests in Sacramento over the death of George Floyd, a black man killed by Minneapolis police officer Derek Chauvin on May 25.

An analysis of the bill prepared for the June 1 hearing, which has since been removed from the Legislature’s website, estimates the measure would cost the Department of Industrial Relations at least $10 million.

“There are a variety of factors related to the nature of the disease, its treatment, and general response to the pandemic that could influence the fiscal impact of this bill,” the analysis reads. “These unknown variables and the evolving nature of COVID-19 infection rates make any fiscal estimate for this bill subject to considerable uncertainty. DIR’s estimate is based only on those workers who fall within the categories of health care providers and first responders, as they are the most likely to be considered ‘critical workers.’ To the extent the population of ‘critical workers’ was expanded beyond that base, resulting costs would be higher.”

The CWCI report, “Integrating COVID-19 Presumptions Into California Workers’ Compensation,” is available on the CWCI research page, here.