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California employers have COVID-19 reporting obligations to determine workers' compensation presumption

October 08, 2020 18378

Quick Summary:

Specifically, employers must retrospectively report by Oct. 29 employee positive COVID-19 tests that occurred between July 6 and Sept. 17 and report within three business days any employee positive COVID-19 test that occurred on Sept. 18 and going forward.

Employees in California may be entitled to workers’ compensation if they test positive for COVID-19 or if their place of employment experiences an “outbreak” of COVID-19 as defined by legislation signed into law Sept. 17 by Gov. Gavin Newsom. Under the new law, employers have specific reporting requirements to determine whether the levels of positive testing meet the definition of an outbreak.

As CDA previously reported, Senate Bill 1159 by Sen. Jerry Hill (D-San Mateo) took effect immediately as an urgency statute and modifies existing workers’ compensation law by defining an employee injury, when it occurs in the course of employment, to include an illness or death resulting from COVID-19 under specific circumstances through Jan. 1, 2023.

Disputable presumption of COVID-19 injury

For employers that have five or more employees, the law also establishes a disputable presumption of injury for all employees who test positive for COVID-19 during an outbreak if the illness occurs during a specific time frame and meets specific criteria. “Disputable” means the burden is on the employer to prove that the COVID-19 illness did not occur as a result of employment or work.

For dental offices, the presumption applies when one of the following thresholds is met within 14 calendar days:

  • Employers with five to 100 employees: Four or more employees test positive for COVID-19
  • Employer with more than 100 employees: 4% of the employer’s workforce tests positive for COVID-19

Employees must first exhaust all COVID-19-related paid sick leave prior to obtaining wage loss through the workers’ compensation system.

Employer reporting requirements

Employers are responsible for reporting information about positive COVID-19 tests to their workers’ compensation claims administrator within specified time frames and on an ongoing basis for a long as the law is in effect. All employee positive COVID-19 results must be reported regardless of whether the employer learns or believes that the employee contracted the virus from work or outside of the workplace.

Specifically, employers must:

  • Retrospectively report by Oct. 29 employee positive COVID-19 tests that occurred between July 6 and Sept. 17
  • Report within three business days any employee positive COVID-19 that occurred on Sept. 18 and going forward

The law states that “when an employer knows or reasonably should know that an employee has tested positive for COVID-19, the employer shall report to their claims administrator” by email or fax within three days the following:

  • An employee tested positive for COVID-19 (via the polymerase chain reaction, or PCR, test only)
  • The date the employee tested positive (date specimen was collected for testing)
  • The address or addresses of the employee’s place of employment during the 14-days preceding the date the employee tested positive for COVID-19
  • The highest number of employees who reported to work at the employee’s specific place of employment in the 45-day period preceding the last day the employee worked at each specific place of employment

Reporting assistance available for TDIC policyholders

Employers should contact their insurance carrier to obtain the carrier’s reporting process.

The Dentists Insurance Company has partnered with Sedgwick, a claims management services company, to simplify this process for TDIC Workers’ Compensation policyholders to fulfill their reporting obligations under the new law. Policyholders can use Sedgwick’s spreadsheet to capture all COVID-19-positive tests for employees, including all the reporting data elements required by law. The spreadsheet must be emailed to Sedgwick at [email protected] within the required reporting timelines.

Sedgwick will run nightly calculations to determine if an outbreak has occurred at a policyholder’s practice by reviewing outbreak data for each employer to confirm accuracy as well as identifying previously reported claims that may require application of the COVID-19 presumption.

TDIC policyholders can access the reporting spreadsheet and receive further details about these requirements by visiting the Workers’ Compensation page on the TDIC website.

Policyholders who have questions about the new reporting requirements can contact TDIC’s Risk Management Advice Line at 800.733.0633.