COVID-19 Workers Comp Claim from Spouse Rejected

California Employers received some potentially GOOD news from a California Federal Judge with respects to Liability arising out of a COVID-19 workers comp claim. 

During the last week of February 2021; a California Federal Judge dismissed a claim made by a spouse of an employee who allegedly contracted COVID-19 while on the job.  The plaintiff alleged that she contracted COVID-19 from her husband who had contracted the virus while at work. 

The dismissal was given with leave to amend the claim, so the Plaintiff may elect to revise and refile their claim; but as of now this is a positive indication as to how California courts may elect to view and decide on future claims.

A summary of the complaint and the situation may be found from The National Law Review at the following link:

COVID-19 Workers Comp Background

Workers’ compensation is a no-fault system that provides medical expenses and lost-income replacement for employees who sustain injuries or illnesses that arise out of and in the course and scope of their employment.

Each state has its own workers’ compensation law that governs the process of determining whether an injury or illness is work related and therefore compensable. Under California’s workers’ compensation law, employees typically have the burden of proving that any claimed condition is work related.  

On May 6, 2020, however, California’s governor issued Executive Order N-62-20 to reverse that burden for employees who were diagnosed with or tested positive for COVID-19 within 14 days after working at their places of employment between (and including) March 19 and July 5, 2020.  On Sept. 17, 2020, the state enacted SB1159 to add the provisions of that order to the state’ workers’ compensation law and to extend the presumption that COVID-19 is work related to certain employees through Jan. 1, 2023.

COVID-19 Workers Comp

New Presumptions Under SB1159

SB1159 creates a new presumption that COVID-19 is compensable for the following types of workers, if they test positive for COVID-19 within 14 days after working at a place of employment (not including their own homes), at an employers’ direction, on or after July 6, 2020:  

  • Active firefighting members (including volunteers) of various, local, state and federal fire departments;
  • Peace officers who primarily engage in active law enforcement activities;
  • Fire and rescue services coordinators who work for the Office of Emergency Services;
  • Health facility workers who provide direct patient care to or come into contact with COVID-19 patients; 
  • Certain registered nurses, emergency medical technicians and emergency medical technician-paramedics;
  • Workers who provide direct patient care for a home health agency; and
  • Workers who provide in-home supportive services outside their own homes.

In addition, SB1159 extends the presumption to any employee who tests positive for COVID-19 within 14 days after working at a place of employment, at an employers’ direction, on or after July 6, 2020, if:  

  • The employer has five or more employees; and
  • The employee tests positive during an outbreak at the employee’s specific place of employment.

For this purpose, an “outbreak” exists when:  

  • Four employees at a specific workplace test positive for COVID-19 within a 14-day period, if the employer has 100 employees or fewer at that workplace;
  • Four percent of the employees who reported to a specific workplace test positive for COVID-19 within a 14-day period, if the employer has more than 100 employees at that workplace; or
  • A specific workplace is ordered to close by a local or state public health authority due to COVID-19-related risk.

A specific workplace means the building, facility, store, field or other location where an employee performs work at the employer’s direction. It does not include an employee’s home, unless the employee provides home health care services to another individual there.

Disputing COVID-19 Workers Comp Claims

When an employee is presumed to have a compensable claim for COVID-19, the employer may present evidence to rebut the presumption. Types of evidence that may help prove that an employee did not contract COVID-19 on the job include, for example, any measures the employer has in place to reduce potential transmission in the employee’s workplace and any nonoccupational risks of COVID-19 infection the employee may have.

An employer that wishes to dispute an employee’s presumptively compensable claim for COVID-19 must formally reject liability within either 30 days (for claims that do not depend on the existence of an outbreak for the presumption) or 45 days (for claims associated with an outbreak). Otherwise, the employer will be barred from using any already-discovered evidence to dispute the claim.

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