Business Insurance Magazine published a report on a recent Out Front Ideas webinar, entitled “COVID Claims Development: Workers’ Compensation & Beyond,” Experts in the workers’ comp line of business came together to discuss the long-term medical complications that are arising from the virus and what they’ve seen so far in terms of COVID-19 claims.

Coronavirus long-haulers have been in the news for some time now, with symptoms from the virus stalking them for months after they’ve contracted it. This in turn has had implications for workers’ comp claims, but what’s coming down the pike for such claims is yet to be determined.

Pointing to a National Institute for Health Research study that followed more than 4,000 people in the United States, “What they found is that 50% of the people were unable to work full-time six months after they tested positive for COVID, and only 8% of those people actually were hospitalized so they weren’t the most severe cases,” said Teresa Bartlett, senior medical officer at Sedgwick. She added that “88% of people said that they were coping with some form of cognitive dysfunction – and that is such a difficult thing to deal with [on the claims side].”

Studies on ‘long’ COVID-19 are still only in their infancy, but there’s clearly some cause for concern. Respondents have highlighted issues related to hair loss, cardiomyopathies, and blood clots in the legs, among many other symptoms. Healthcare workers, who have been on the frontlines for the entirety of the pandemic, are likewise being watched closely for signs of Post-Traumatic Stress Disorder. “It’s something that we have to be very mindful of in our industry, and we have to be prepared for how we will deal with it,” noted Bartlett.

As for workers’ comp claims that have arisen out of COVID-19 already, there are challenges here as well, particularly in identifying trends and predicting future impacts. That’s partly because there’s no single source for workers’ compensation information in the US, with data split across the NCCI, multiple independent bureaus, and monopolistic states.

Another factor that poses a challenge to workers’ compensation data analysis is the existence of self-insured employers, who, for the most part, do not report their data to any of the bureaus. Several top industries by employment in the US are mostly self-insured and collectively represent over 30% of the jobs across the top 20 industries. Additionally, a significant portion of the healthcare industry is also self-insured – and all of this data is missing from the bureaus’ analyses, noted Walls.

One of the places that does provide access to a robust set of workers’ compensation data is the California Workers’ Compensation Institute (CWCI). A deep dive into the institute’s figures reveals key trends in workers’ comp claims tied to COVID-19 so far.

“California as a whole had about 13% of the infections and about 10% of the deaths [in the US],” said Alex Swedlow, president of CWCI, but he also noted, “Only about 4.7% of the California working age infections had a corresponding workers’ compensation claim, and about 5.6% of California’s working aged fatalities had an accompanying workers’ compensation claim.”

As of March 22, 2021, there had been almost 140,000 COVID-19 claims reported in California, with healthcare taking the lion’s share at 31.9%, followed by the public sector at 16.9% and retail at 10.3%, according to the CWCI. COVID-19 is also taking the heat off of other causes of workers’ compensation claims.

The characteristics of COVID-19 claims have also evolved since early reporting days. The healthcare industry’s share of claims has slowly dropped over time, though transportation has surged due to the partial opening up of the California economy. When it comes to regional analysis, Swedlow pointed out that regional infections have been relatively stable, with Los Angeles unsurprisingly being a constant and key center of infections.

Despite having some data to look at, a lot of what’s to come in the workers’ compensation space with regards to COVID-19 is still up in the air; some experts compare making predictions about future trends to trying to look into a crystal ball.

The Division of Workers’ Compensation has received notification from the Office of Administrative Law that the final version of the proposed Medical-Legal Fee Schedule was forwarded on March 30, 2021 to the office of the Secretary of State for filing and printing.

This action represents official adoption of the new fee schedule, which has an effective date of April 1, 2021. All medical-legal evaluations that occur on or after April 1, 2021 will be subject to the new MLFS.

DWC has posted on its website the final rulemaking documents filed with OAL. The documents include the final text of the new MLFS.

The MLFS provides that a declaration to the physician accounting for the records that were provided is required by the proposed regulations for evaluations that occur on or after April 1, 2021.

The language states: “Any documents sent to the physician for record review must be accompanied by a declaration under penalty of perjury that the provider of the documents has complied with the provisions of Labor Code section 4062.3 before providing the documents to the physician. The declaration must also contain an attestation as to the total page count of the documents provided. A physician may not bill for review of documents that are not provided with this accompanying required declaration from the document provider. Any documents or records that are sent to the physician without the required declaration and attestation shall not be considered available to the physician or received by the physician for purposes of any regulatory or statutory duty of the physician regarding records and report writing.’

DWC realizes that there are Qualified Medical Evaluator evaluations currently scheduled for April that may not comply with the provisions of the attestation requirement for medical records under the new Medical-Legal Fee Schedule. The parties to these evaluations should communicate with each other to reach agreement on the handling of these evaluations.

Senate Bill 95’s supplemental COVID paid sick leave requirement goes into effect as of March 19, 2021. The new law mandates that employers provide employees with supplemental paid sick leave for COVID-related leave in addition to other paid time off obligations under existing federal, state, or local statutes.

The obligation to provide paid COVID related sick leave is also retroactive to January 1, 2021. Upon an oral or written request by an employee, the employer is obligated to reimburse an employee who took leave between January 1, 2021, and March 29, 2021, that would have otherwise qualified under SB 95.

Under Labor Code 248.2 all employers with 26 or more employees must allow all employees who are unable to work or telework due to COVID use of the new supplemental paid sick leave. The employee qualifies for leave if the employee:

A. Is subject to a quarantine or isolation period related to COVID.
B. Has been advised by a health care provider to self-quarantine due to concerns related to COVID.
C. Is attending an appointment to receive a vaccine for protection against contracting COVID.
D. Is experiencing symptoms related to a COVID vaccine that prevent the employee from being able to work or telework.
E. Is experiencing symptoms of COVID and seeking a medical diagnosis.
F. Is caring for a family member who is subject t ho a quarantine or isolation period related to COVID; or who has been advised to self-quarantine by a health care provider.
G. Is caring for a child whose school or place of care is closed or otherwise unavailable for reasons related to COVID on the premises.

Full-time qualified employees are eligible for up to 80 hours of supplemental paid sick leave. Non-full-time employees with normal weekly schedules receive the total number of hours they are normally scheduled to work over two weeks. Employees who work a variable number of hours, whose tenure is six months or more, receive 14 times the average number of hours they worked each day in the six months preceding their leave date.

In addition, as with all other paid sick leave requirements mandated by law in California, there are posting requirements and a requirement that the leave hours be available on paystubs or other written notices to employees received on payday.

SB 95 is nuanced and specific with regard to the qualifications, exemptions, and obligations.

The firm of Roxborough Pomerance Nye & Adreani LLP has invited employers to contact members of the firm about this new law if necessary If your company has any questions about the new paid sick leave requirements, please contact Nicholas Roxborough at (818) 992-9999, ext. 222, Drew Pomerance at ext. 212, Michael Adreani, at ext. 234, Marina Vitek, at ext. 236, or Trevor Witt, at ext. 224.

Despite the softening of rates and the challenges of the coronavirus pandemic, the Insurance Journal reports that one Midwest-based workers’ compensation insurance provider that opened its doors just over three years ago reports that it not only has experienced significant growth during that time, it simultaneously has managed to maintain a loss ratio that is one of the lowest in the industry.

Since its launch in October 2017, Omaha National, based in Omaha, Nebraska, has gone from $0 to $100 million of in-force premium and grown from a six-person operation to one with more than 150 employees.

That brisk pace of growth is expected to continue, says Reagan Pufall, president and CEO of the managing general agent (MGA) / insurance carrier. The company will move into a new office building this summer “because we’ve run out of room where we are,” he said. “Five years from now, we expect to be well over $400 million in-force premium.”

Omaha National launched as an MGA with California as its initial target market. It is now offering coverage in 14 states and will continue to expand into other states, including New York this year, Pufall said. It also established Omaha National Insurance Co., which currently “acts as a reinsurer for a portion of the risk that we write. So even as an MGA, we are already on the risk, which is what we like.”

However, “the intention has always been to become a direct writer. And we’re now approaching the time when it looks like we will be able to initiate that transition to becoming a carrier,” he said.

A complementary division of the company is its payroll service. “It’s an optional part of what we offer. Any company that is insured by us, if they choose, they can also make use of us as their payroll service,” Pufall said.

Small- to mid-size companies operating in industries where employees work with their hands are Omaha National’s core customers – landscapers, framers, electricians, plumbers, parcel delivery services, for example. “We like to say that we insure the companies that build America,” Pufall said.

The falling rates in the workers’ compensation line are a challenge as they are for any insurer, Pufall said. “But we designed this company to prosper throughout the market cycle, in hard markets and soft markets. None of what we’re encountering or anything we see in the future causes us substantial concern. Of course, we will look forward to the day when the market cycle changes, and the rates are rising again. But until then, we’re doing just fine, even during this soft market.”

The wave of COVID-19 claims that hit the California workers’ compensation system at the end of 2020 has subsided for the time being as the number of claims reported to the state Division of Workers’ Compensation for February fell to the lowest level in a year, an analysis by the California Workers’ Compensation Institute Shows.

The CWCI report shows the projected ultimate claim count for February came in at 4,533 cases, down nearly 90% from the record 43,158 claims projected for December.

The figures from CWCI’s COVID-19/Non-COVID-19 Interactive Application show that after surging to an all-time high in December, the monthly COVID-19 claim count fell by more than 50% in January, a decrease that coincided with the steep drop in new coronavirus cases in the state.

“Claim counts from December through February are still incomplete as additional claims for those months are still being reported, but the COVID-19 claim totals reported as of March 8 show that the DWC has recorded 40,188 claims with December injury dates and 19,493 claims with January injury dates, but just 2,747 COVID-19 claims with February injury dates,” the CWCI report states.

The addition of the February figure pushed the number of virus claims reported to the DWC since the pandemic began to 135,566, including 751 death claims, and COVID-19 clams have accounted for just 9% of all claims reported thus far for February, though they have accounted for 18.8% of all claims since the first claims were reported in January of 2020, according to the CWCI.

The latest results are from the March 11 update to CWCI’s COVID-19/Non-COVID-19 Interactive Claim App, which integrates data from CWCI, DWC, and the Bureau of Labor and Statistics to provide current and historical data on California work injury claims.

The app includes COVID-19 data dating back to January 2020, as well as from the most recent 12 months, and is available to the public.