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:
- The employee tested positive for or was diagnosed for COVID-19 within 14 days of working at their place of employment
- The employee was working on or after March 19, 2020
- The employee was not working from home during that time period, and was mandated by the employer to work from the employer’s location
- 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%.
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.
- 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.