Executive Order Makes it Easier For Essential Workers in California to Obtain Workers’ Compensation Benefits
On Tuesday, May 6, 2020, Governor Newsom signed an executive order that will make it easier for essential workers who contract COVID-19 to obtain workers’ compensation benefits. This order creates a rebuttable presumption that California’s essential employees who contract COVID-19 in the course of their employment are eligible for workers’ compensation benefits.
This order will broaden benefits to all sectors, as long as the employee tests positive for COVID-19 by a physician. In addition to healthcare and first responders, the executive order also covers grocery and warehouse personnel, truckers, delivery drivers, and others considered essential who are working during the current pandemic. The presumption will be in place for the next 60 days (July 5, 2020) and it covers claims dating back to March 19, 2020.
Highlights of the Order:
Any COVID-19-related illness of an employee shall be presumed to arise out of and in the course of the employment (AOE/COE) for purposes of awarding workers’ compensation benefits, if the following requirements are satisfied:
- Employee must test positive for or was diagnosed with COVID-19 by a physician who holds a physician and surgeon license issued by the California Medical Board, and the diagnosis was made within 14 days after a day that the employee performed labor or services at the employee’s place of employment, at the employer’s direction;
- Employee performed labor or services at the place of employment, at the employer’s direction, on or after March 19, 2020;
- The employee’s place of employment is not the employee’s home or residence; and
- The diagnosis of COVID-19, was done by a physician who holds a physician and surgeon license issued by the California Medical Board and that diagnosis is confirmed by further testing within 30 days of the date of the diagnosis.
If the claim is accepted for COVID-19-related illness, the employee is eligible for all benefits applicable under the workers’ compensation laws of this state, including full hospital, surgical, medical treatment, disability indemnity, and death benefits, subject to Labor Code sections 4663 and 4664.
The claim can only be denied within 30 days of the day “the Employee Claim Form, DWC-1 claim is filed under Labor Code section 5401,” rather than the 90 days allowed under Labor Code section 5402, unless there is rebutted evidence discovered subsequent to the 30-day period. If the claim is not denied within the 30 days, it shall be presumed compensable.
Utilization Review/Independent Medical Review will still apply to medical treatment prescribed to treat the COVID-19 condition, as well as apportionment of permanent disability.
The employee must be certified for temporary disability (TD) within the first 15 days after the initial diagnosis, and must be re-certified for temporary disability every 15 days thereafter, for the first 45 days following diagnosis, to qualify for temporary disability under Labor Code section 4850.
If the employee tested positive or was diagnosed prior to May 6, 2020, the employee must obtain a certification by May 21, 2020, to document the period of TD, and must be re-certified for temporary disability every 15 days thereafter, for the first 45 days following diagnosis. The temporary disability must be certified by a physician, including MPN providers, a predesignated physician, or a physician in the employee’s group health plan. If the employee does not have a designated workers’ compensation physician or group health plan, the employee should be certified by a physician of the employee’s choosing who holds a physician and surgeon license.
If you have any questions, please contact your EPIC representative or WC Claims Advocate.
For more of EPIC’s coronavirus coverage, visit epicbrokers.com/coronavirus