COVID-19 Advisory Call Q&A
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On Thursday, March 13, 2020, SORM conducted an advisory call with risk managers, workers’ compensation claims coordinators, and continuity of operations planners to address questions regarding the COVID-19 coronavirus. Following are answers to the questions we received:
When employees seek treatment [for work exposure] through doctor-on-demand and are only given a prescription should that case be reported to SORM?
Any time an injured employee seeks medical treatment or incurs medical expenses and if the employee is contending or the employer has reason to believe that exposure may be work-related, notice should be filed with SORM.
If an employee contracted a contagious disease at work, but possibly outside of typical course and scope but taking pre-emptive measures, is there a potential for coverage?
A compensable injury must originate in the work, business, trade, or profession of the employer that is performed by an employee while engaged in or about the furtherance of the affairs or the business of the employer. Contracting an ordinary disease of life (COVID-19 is currently classified as such) to which the general public is exposed outside of employment may not be a compensable injury under the law, even if it happens to occur in the workplace. However, every claim will be fully investigated on a case by case basis. Potential lost wages for exposure concerns (for example, self-quarantine without positive confirmation of infection) would generally be handled under leave provisions or other announced government policies. If an employee is relating an exposure to their employment, these should be filed to SORM for further investigation.
Is testing for a contagious disease covered?
Currently, broad-form testing is only covered for a limited subset of state employees (law enforcement officers, fire fighters, emergency medical service employees, paramedics, and correctional officers) or specific conditions (HIV). See Rules 122.3 and 122.4. Policy changes within or external to the workers’ compensation system may be announced by other governmental authorities in future, and will be complied with, as applicable, by SORM.
How does an agency mitigate our liability in this case?
Please refer to the following resources:
Where would the employees be sent for testing?
Employees that require testing for the condition with a suspicion of work exposure should contact a workers’ compensation approved physician to determine where they can have the testing completed.
As things are changing daily, we could refer them to the CDC website for treating facilities: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html.
Should we limit employee travel to parts of state where there is community spread of COVID-19, such as Houston?
This determination must be made by the individual entity considering its essential functions and necessity of travel given potential for exposure. Please refer to the following resources: https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-in-the-us.html.
If the employee submits a claim due to the COVID-19, are there specific hospitals that perform the testing for the virus as well as treating the virus? Can the virus be treated by their local PCP or within the network?
As COVID-19 is a new condition there may be providers that are unable to assist with the appropriate testing. If an employee needs medical treatment related to this condition, they will need to contact the provider’s office and/or hospital to determine if they have the appropriate means of handling the care.
For those who work with the public, like driver license employees, would that be the exception for testing coverage?
Currently, there are no provisions within 122.3 to accommodate employees other than those specifically addressed. As discussed above, however, each claim is different so there is no one dispositive answer. There may be a potential for coverage based on the information received during the adjuster’s investigation. The employee will have to provide evidence that the exposure was sustained during the course and scope of their employment (versus other means of exposure) such that the injury must originate in the work, business, trade, or profession of the employer that is performed by an employee while engaged in or about the furtherance of the affairs or the business of the employer. While an ordinary disease of life to which the general public is exposed is generally not compensable, if an employee is relating an exposure to their employment, these should be filed with SORM for further investigation.
If all or part of our workforce is required to work remotely (from home), would claim handling or compensability differ or be affected?
When an agency approves a telework position there will need to be authorization from the head of the agency [or potentially his or her official designee(s)] pre-approving telecommuting/telework for it to be compensable. See Martinez vs. State Office of Risk Management for further information on the Government Code provisions supporting this requirement.
Each claim received from a telecommuting process will be investigated to determine compensability. During the investigation the adjuster will review for course and scope, along with determining the causal relationship of the injury to their work. If the employer has a telecommuting agreement with the employee, that would also be reviewed in the determination of whether the injury occurred in the approved course and scope of the employment. with determining the causal relationship of the injury to their work. If the employer has a telecommuting agreement with the employee, that would also be reviewed in the determination of whether the injury occurred in the approved course and scope of the employment.
At what point would agencies be required to work from home and for how long?
This is in the discretion of each individual agency. Any requirements directing State employees to any particular action will come from the head of that state agency or an appropriate authority entity or state hierarchy.
Will agencies have access to the kits for testing? Is there training for conducting the tests?
SORM has not been advised of government efforts to provide testing kits to individual entities at this time. Testing should only be performed by qualified medical personnel. Determinations on the availability of testing kits and the proper officials to administer the tests will be likely made by the CDC working in conjunction with the Office of the Governor, the Texas Department of Health and Human Services, and other lead response agencies.
Should multiple agencies occupying the same physical space (same building) facilitate information sharing on cases and suspected exposure, (without disclosing underlying medical information)?
Tracking and sharing of information is encouraged for the purposes of disclosure, so long as the identity of the individual is protected. The TFC, for example, has promulgated reporting protocols for this purpose.
If employees who does not have the ability to work from home due to technical reasons, but the workplace has been deemed unsafe or compromised, would this fall under an Emergency Leave situation? Would employees be compensated if employee cannot report to duty?
We would refer this to your agency’s legal department for final determination. Unless otherwise determined by state leadership, all statutory provisions respecting proper use of leave must be adhered to. The granting of emergency leave is generally appropriate if no other leave is available and if it has been duly approved by the chief administrator of the entity. Whatever determination is made by the entity should be applied objectively and consistently.
At what point does an agency report a case to SORM? When it’s a positive exposure? Or they just suspect it?
Agencies may report an “incident” in to SORM’s RMIS database for any suspected exposures. If the injured employee seeks medical treatment and/or testing or has lost time from work due to the claimed exposure, then the claim would need to be reported. Any incidents reported in RMIS may easily be converted into an active claim.
Can you clarify what data to report for a potential incident (e.g. exposure by employee whether exposed at work or not)?
If an injured employee has suspected exposure, then any information surrounding the exposure should be reported as an incident to SORM if related to employment. If the injured employee seeks medical treatment and/or testing or has lost time from work due to the claimed exposure, then the claim would need to be reported.
So, incidents are done electronically within RMIS only (non-paper)?
SORM requires all incidents and/or claims filed to our agency via the RMIS system (electronically). If it is not possible to report via RMIS, please contact SORM for options for potential manual or alternative reporting.
At what point does said type of incident become an actual exposure claim?
When an injured employee seeks medical treatment and/or testing or has lost time from work related to the exposure, it would be considered a claim and SORM will begin formal investigation and claims adjustment.
Do the suspected cases only get entered into RMIS and the confirmed COVID-19 cases come in the paper form?
Any suspected workplace exposures without medical treatment nor testing would be an incident only. An employee that seeks medical treatment and/or testing or has lost time from work and is relating the exposure to employment would require a DWC1s (First Report of Injury) to be filed via the SORM RMIS database.
When does an incident become a claim (when medical treatment is administered or sought)?
Any suspected workplace exposures without medical treatment, testing or lost time would be an incident only. An employee that seeks medical treatment and/or testing and is relating the exposure to employment would require a DWC1s (First Report of Injury) to be filed via the SORM RMIS database.
What about employees that use the on-line physician benefit – who provide prescriptions first before reporting to agency?
Any time an injured employee seeks medical treatment or incurs medical expenses these claims should be filed to SORM.
Just confirming that if we identify someone as having been exposed to COVID-19 that we should enter the event as an incident in RMIS. If there is a confirmed case, we would enter it in RMIS as a claim. Is this correct?
Any suspected workplace exposures without medical treatment nor testing would be an incident only. An employee that seeks medical treatment and/or testing or have lost time from work and is relating the exposure to employment would require a DWC1s (First Report of Injury) to be filed via the SORM RMIS database. The claims detail will be adjusted based on any new information received.