Workers’ Compensation is insurance coverage that most employers are required to carry. This insurance provides missed income and medical bill reimbursement coverage for workers who get injured on the job. When thinking of workplace injuries, most people assume construction and other hazardous work is the only type of work that would qualify for Workers’ Compensation. Actually, workers in any field can get injured on the job and could be eligible for Workers’ Compensation benefits.
As many businesses try to remain open and provide both essential and non-essential services, workers may be exposed to the Coronavirus (COVID-19) through the course of their daily duties. Because this is no fault of their own, they may also be entitled to Workers’ Compensation benefits. If you have suffered injuries at work because of COVID-19 or even unrelated to the pandemic, you may be eligible for Workers’ Compensation benefits. To find out more, speak with an experienced lawyer who can review your case.
Workers’ Compensation Eligibility
In most places, any worker who is employed for a company that is required to carry Workers’ Compensation insurance is eligible to receive benefits. Workers’ Compensation does not require that an injured employee prove they were not at fault for their injuries. One of the few ways a worker would not be eligible for benefits is if they intentionally injured themself at work.
But what about getting COVID-19 at work or caring for a sick family member? Is that covered under Workers’ Compensation? Ultimately, there is no simple answer, and it depends on the specific situation.
Employee contracts COVID-19 at work. COVID-19 is inherently contagious, so proving that an employee caught the virus at work might be challenging. However, if a worker can show that they were exposed to and contracted COVID-19 at work, they will probably qualify for Workers’ Compensation benefits. In most cases, an employee will need to formally report their illness, along with a positive test result, to their employer within just a few days after becoming aware.
Employee is caring for family member with COVID-19. This is where things get complicated for workers. Unless an employee is exposed to COVID-19 at work, they probably cannot get Workers’ Compensation benefits. Contracting the virus outside work would not qualify as a work-related illness and caring for a family member who has COVID-19 is also not a work-related illness that would be covered under an employer’s Workers’ Compensation plan.
Employee is exposed to COVID-19 at work but not showing symptoms. When an employee gets exposed to COVID-19 at work, it usually happens because a colleague has tested positive. This does not mean that the exposed employee will absolutely contract the virus, but they should be careful and, if not vaccinated, should be quarantined. This is a situation in which the employee who was exposed to COVID-19 but not yet showing symptoms may be eligible for Workers’ Compensation benefits.
Doctor told employee to stay home from work. If an employee saw their doctor because they feared they may have been exposed to COVID-19, their doctor may have told them to be cautious and quarantine, especially if they were not vaccinated. The only way this might fall under a Workers’ Compensation claim is if the employee was exposed to the virus while at work. Otherwise, the employee would probably not have a claim for a work-related illness, even though they are doing what is best for themself and for people around them.
Employee is afraid to go to work and risk exposure. Being cautious during a global pandemic is a prudent move. Unfortunately, it is not a move for which an employee would receive support under their employer’s Workers’ Compensation policy. If a worker was exposed to COVID-19 at work or there are other circumstances that might make their fear work related, they may have a valid reason to file a Workers’ Compensation claim.
Employee laid off because of the pandemic. An employee will most likely not qualify for Workers’ Compensation coverage if their employer laid them off or closed because of a lack of business caused by the pandemic. However, if an employee was out of work because of COVID-19 and was then laid off, they may have a claim for wrongful termination and should seek the advice of legal counsel.
Proving a Workers’ Compensation Claim
To prove a Workers’ Compensation claim for COVID-19, an employee would need to first show that they have contracted the virus. This is the straightforward part, and they would simply provide a positive test result and possibly a note from their doctor describing their symptoms and prognosis.
The more difficult step for the employee will be proving that they contracted COVID-19 at work. Even though an employee does not have to prove their employer was negligent or reckless in any way, proving that a worker caught a highly contagious virus at work and not somewhere else can be difficult.
The best way to boost the claim is for the sick employee to keep close track of their medical care. They should note information such as the following:
- The date of first symptoms
- The type of symptoms
- Activities besides work in which the employee participated for a week leading up to symptoms appearing
- How many days after symptoms appeared the employee tested positive
It is also important that any employee keeps copies of their medical records. The Workers’ Compensation insurance company will likely request these records, so having them handy can help to speed up the process.
Workers’ Compensation Benefits
Workers’ Compensation benefits specifically cover two major items: medical bills and wage loss. For medical bills, this can include:
- Reimbursement of medical bills already paid
- Paying future medical bills on the employee’s behalf
- Covering hospital stays, prescription medication, and possibly rehabilitation
- May cover ongoing medical care if directly related to the covered illness
Beyond medical bills, Workers’ Compensation insurance will also cover lost income. But it may not cover the entire salary that an employee would have otherwise earned. In Delaware, an employee out of work due to a covered injury on the job may only receive approximately two-thirds of their average weekly pay.
Appealing a Claim Denial
When an employee files a Workers’ Compensation claim, they are often shocked to receive a fairly prompt denial of their claim. Employees must remember that the insurance company covering their employer’s Workers’ Compensation plan does not want to pay out a claim, just like any other insurance company. Because of this, they will often deny a claim outright, hoping that an employee does not appeal the decision.
Ultimately, an employee always has the right to appeal. If a worker has received a denial of their Workers’ Compensation claim, they may be able to appeal that decision. Oftentimes, the insurance company simply denies the claim for not providing the exact information they requested. Instead of giving a claimant time to resubmit the appropriate paperwork, the insurance company just denies the claim.
Wilmington Workers’ Compensation Lawyers at McCann Dillon Jaffe & Lamb, LLC Help Injured Workers Understand Their Rights
Getting injured at work can be scary. That anxiety is only increased when you get injured during the COVID-19 pandemic. Whether you are entitled to Workers’ Compensation benefits under your employer’s policy depends on several factors. To help you understand your rights and legal options, as well as figure out the best path forward for you, speak with the Wilmington Workers’ Compensation lawyers at McCann Dillon Jaffe & Lamb, LLC. Call us today at 302-888-1221 or contact us online. Located in Wilmington, Delaware, we serve clients in Dover, Newark, and Middletown.