One month has passed since California Governor, Gavin Newsom issued Executive Order N-62-20, creating the rebuttable presumption of compensability for COVID-19 clams that meet specific criteria. The Order extends from May 6 through July 5 of this year and applies to COVID-19 claims for dates of injury on or after March 19, 2020, when the following four conditions are met:
  1. The employee tested positive for or was diagnosed for COVID-19 within 14 days of working at their place of employment
  2. The employee was working on or after March 19, 2020
  3. The employee was not working from home during that time period, and was mandated by the employer to work from the employer’s location
  4. The diagnosis was made by a licensed California physician. The diagnosis is confirmed by testing within 30 days of the date of the diagnosis
Athens has been closely following the impact of COVID-19, both before and after the Executive Order issued, and we wanted to share what we are seeing on COVID-19 claims.

Claim Reporting Rates

Not surprisingly, after the May 6 Executive Order issued, Athens saw a significant increase in claims reported for dates of injury from March 19 – May 5.
Since the Order: New claim submissions for dates of injury between March 19 and May 5 have increased 32%
The largest increase was seen among our healthcare industry clients, with a 29% increase in new claims filed (or 76% of all claims filed retroactively). Two thirds of those claims involved employees who provide direct patient care.
Since the Order: The total number of new COVID-19 claims reported for all dates of injury decreased by 9%.

Claim Investigations

This Executive Order reduced the time legally allowed to investigate a claim from 90 days to only 30 days for COVID-19 claims.
Prior to the Order:  The average compensability determination was made within 10 days of the date the claim was entered.
Since the Order: The average time to reach a decision went down to 6 days from the date of entry.
*Note: We expect the number of days to increase as the State moves forward with reopening, as this will necessitate additional review of potential outside exposures.

Compensability Determinations

  • 48% of all COVID-19 claims entered have been accepted
  • 31% of COVID-19 claims are denied
  • Since the Executive Order issued, only .08% of claim denials have been reversed in response to the Order
  • 86% of claim denials are based on negative or no test results
  • 21% of COVID-19 claims remain under investigation

Misc. Claim Facts

  • .03% of claims have resulted in death
  • 2.7% of injured workers were hospitalized
  • 29% of cases involving hospitalization have closed
  • .08% of claims are litigated
  • The average claim has remained open for 22 days
  • The average incurred claim cost is $5,543
  • The average incurred cost for open claims only is $13,590
  • The highest incurred amount is $188,038
  • 74% of claims come from healthcare clients
  • 59% of claims come from patient-facing healthcare workers
  • 20% of claims come from public agency clients
  • 15% of claims come from administrative or clerical employees working in healthcare, public agencies or social services organizations
  • 8% of claims come from Police, Sheriff or Correctional Dept. employees
Athens will continue to monitor the impact of the pandemic, and will provide updates on any significant developments.