Coronavirus and N.C. Workers’ Compensation Benefits
As essential workers ranging from doctors and nurses to construction workers and grocery store clerks continue to report to work in North Carolina during the COVID-19 coronavirus pandemic, many can be expected to contract the virus. Those who develop serious infections could face tens of thousands of dollars in hospitalization bills, according to estimates.
The question is whether a company’s workers’ compensation insurance will pay for medical treatment of COVID-19 acquired while on the job. The answer is that North Carolina workers’ comp may or may not cover the medical costs of treating coronavirus contracted in the workplace.
This is an open question, as many things about the COVID-19 pandemic are changing from week to week. If you or a loved one has been diagnosed with the COVID-19 coronavirus and you believe it was directly tied to job duties, we suggest that you take the steps to gather documentation of your employment status and illness and contact Hardison & Cochran in Raleigh.
Our workers’ compensation lawyers handle claims across North Carolina. We are staying on top of developments in North Carolina workers’ comp law and court decisions affecting COVID-19 cases. An initial phone consultation with Hardison & Cochran is free. Our office is taking precautions and observing social distancing and other COVID-19 safety protocols to try to prevent the spread of COVID-19.
Are North Carolina Workers Being Exposed to COVID-19?
In North Carolina, Gov. Roy Cooper issued an executive order on March 27 ordering state residents to stay home and for businesses to close or to order employees to work from home to curb the spread of the COVID-19 coronavirus. The order declares that “it is necessary that certain businesses, essential to the response to COVID-19, to the infrastructure of the state and nation, and to the day-to-day life of North Carolinians, remain open.”
There are 29 types of businesses, followed by a list of seven types of retail establishments, declared essential and allowed to remain open. The first exemption to the stay-at-home order is for:
“Businesses, not-for-profit organizations or educational institutions that conduct operations while maintaining social distancing requirements:
a. Among its employees; and
b. Among employees and customers except at the point of sale or purchase.”
The list of specific exemptions includes healthcare and public health services, grocery stores, drug stores, religious entities, media companies, hardware stores, critical trades (construction, plumbers, electricians, etc.), restaurants offering take-out, professional services (lawyers, accountants, architects, etc.), hotels and motels, funeral services and more.
While many of our neighbors are out of work during this pandemic, most North Carolinians continue to go to work every day, many at offices, stores and other worksites where exposure to COVID-19 is certainly possible.
Is Coronavirus Covered By Workers’ Compensation?
Workers’ compensation is no-fault insurance that most businesses in North Carolina are required to purchase to cover their employees. It pays medical benefits and a portion of wages to employees put out of work by injury or illness contracted during the performance of assigned job duties.
Workers’ compensation medical benefits include reimbursement for all medical costs, including hospitalization, medications, rehabilitation, and more.
An April 1 report by CNBC said people hospitalized with coronavirus can expect to pay anywhere from $42,486 to $74,310 if they are uninsured or if they receive care that their insurance carrier deems to be out-of-network, according to independent nonprofit FAIR Health. For those with insurance who use in-network providers, out-of-pocket costs will be a portion of $21,936 to $38,755, depending on the cost-sharing provisions of their health plan.
North Carolina workers’ comp law has a clause that is present in many states’ programs. At General Statutes § 97-53, N.C. workers’ comp law lists about 30 illnesses and conditions that the state considers to be occupational diseases. At § 97-53(13) it adds to the list:
Any disease, other than hearing loss covered in another subdivision of this section, which is proven to be due to causes and conditions which are characteristic of and peculiar to a particular trade, occupation or employment, but excluding all ordinary diseases of life to which the general public is equally exposed outside of the employment.
This final clause in this portion of workers’ comp law may exclude the COVID-19 coronavirus from occupational diseases eligible for benefits.
To be eligible for benefits for a disease, the ill employee would have to show that:
- The disease is identified by statute as an occupational disease, or
- The employee contracted the disease from exposure at a job site and/or while engaging in assigned job duties, or
- The employee, because of their job duties, was at greater risk than the general public of contracting the disease.
It would be important to any workers’ compensation claim to be able to establish how a case of COVID-19 was contracted on-the-job. Certainly, some essential frontline workers such as doctors, nurses and health care workers are at greater risk of exposure to the virus, we would contend.
The National Council on Compensation Insurance (NCCI), which gathers data, analyzes industry trends and advises most U.S. states about workers’ comp rates, offer an answer of “maybe” when asked whether COVID-19 is compensable under state workers’ compensation laws.
Cause for Hope that Workers’ Comp will Cover COVID-19?
Insurance Journal, which publishes business news for the property and casualty insurance industry, says some workers’ compensation claims based on diagnoses of COVID-19 have been filed and more are expected.
While workers’ comp programs are administered by the individual states, the Journal says two states – Kentucky and Washington – have guaranteed workers’ compensation benefits for health care workers and first responders who contract COVID-19.
The NCCI says at least 10 states have issued mandates for general health insurance programs to cover coronavirus. It does not name the states.
“The mandates vary by state, but they include coverage for testing and visits to emergency rooms or urgent care facilities either in-network or out-of-network without deductibles or copays. These measures, if expanded to more states, could have the impact of limiting claim activity in the workers’ compensation market in those cases where only testing or quarantine are necessary,” the NCCI says.
In other words, a lot of power lies with the states and their legislatures to protect their citizens from the expense of contracting the COVID-19 coronavirus.
The NCCI posts state by state workers’ comp and COVID-19 legislative updates on its legislative activity pages. Its North Carolina Legislative Activity page shows no activity related to COVID-19 as of this writing.