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Covid Claims

Has Covid Prevented You from Working? Learn What Legal Options Are Available to You

If you caught COVID-19 as a result of your employment in California, you’re probably wondering if you’re eligible for workers’ compensation benefits, such as payments for medical treatment and lost wages while you’re healing and unable to work. At DLC Law at (626) 285-8815 we can help make this process simple and help ensure you get the benefits you are entitled to. Call DLC Law at (626) 285-8815 now to talk to a Board Certified Workers’ Compensation Specialist by the State Bar of California.

COVID-19 benefits are different from benefits for most infectious conditions

In most cases, getting these benefits for an infectious condition, especially one that is common in the community, is quite difficult for most employees. However, thanks to a California statute established to help residents during the pandemic, if you catch COVID-19 while working, it will be simpler to apply for workers’ compensation if you are a first responder, work in healthcare, or work in a place with a COVID-19 epidemic.

Workers’ compensation rules for COVID-19 depend on your job

If you got COVID-19 while working away from home for a limited time during the state’s initial pandemic shutdown, you were entitled to a presumption that the illness was work-related unless your employer or its insurer could prove otherwise according to an executive order that later became part of California law. Between March 19 and July 5, 2020, you must have tested positive for COVID-19 or been diagnosed with it within 14 days of working at your employer’s workplace.

Since then, the California legislature has passed two laws that extend similar protections to two categories of employees beyond July 5, 2020: those who work in particular occupations that pose a high risk of coronavirus infection and those who test positive during a COVID-19 epidemic at their workplace. The new regulations will be in force until January 1, 2023.

Certain healthcare professionals and first responders will be entitled to a presumption that their disease is work-related if they test positive for COVID-19 within 14 days of working at their employer’s instruction and location. The following are examples of high-risk personnel who are protected by this law:

  • Active firefighters
  • Police officers
  • Emergency medical providers and service coordinators
  • Healthcare employees who provide direct patient care
  • Custodial employees at healthcare facilities who have contact with COVID-19 patients
  • Other employees of healthcare facilities, unless the employer can prove that they have not had contact with a COVID-19 patient in the previous 14 days
  • Providers of healthcare services

If you work in one of these occupations, the insurance company has just 30 days (rather than the usual 90) to dismiss your COVID-19 claim unless it discovers evidence later to refute the presumption that your sickness is covered by workers’ compensation.

Before you can start collecting temporary disability benefits, you must use up any sick leave benefits that have been made available in accordance with COVID-19. The regular three-day waiting time for temporary incapacity will not apply if you do not have access to any coronavirus-related sick leave.

When COVID-19 outbreaks occur in the workplace, is workers’ compensation coverage available?

Even if you don’t qualify for the rule that applies to healthcare workers and first responders, if you develop COVID-19 within 14 days of working at a job site where the disease is spreading, California will assume you have a work-related illness if your employer has at least five employees.

An epidemic occurs when at least four out of 100 or fewer employees at your workplace test positive for COVID-19 during a 14-day period (or 4% of the total if there are more than 100 employees at that site), or officials close the workplace due to the danger of infection.

Your claim has 45 days to be denied by the insurance company. Your company or its insurer may submit information to refute the presumption, such as proof of efforts taken to limit coronavirus transmission at work, as well as your personal risk of infection outside of work.

Although it isn’t expressly stated in the legislation, you should be aware that the insurance company may look at social media posts and other data to see if you or other household members went to restaurants, gyms, or other places where the virus may be spread.

There may be options available to you other than Workers’ Compensation

It’s not impossible to qualify for COVID-19 workers’ compensation payments if you don’t work in the kind of jobs or workplaces protected by the presumptions outlined above. However, it will be more difficult.

Workers’ compensation will not cover an infectious illness in California unless you can prove both that your job involves a special exposure hazard that is greater than the risk in the general public, and that you contracted the disease as a result of a specific, identifiable exposure at work, according to a long-standing rule.

How to file a COVID-19 workers’ compensation claim in California

You must disclose your sickness to your employer within 30 days of the date of injury in order to begin the process of filing for COVID-19 workers’ compensation payments. You must also submit a claim form. Your medical expenses must be paid up to $10,000 while the insurance company decides whether to approve or refuse your claim. You must, however, obey the regulations while choosing your treating physician.

You have the opportunity to appeal if your claim is refused. You can also appeal the insurer’s decision if you don’t get all of the benefits you’re entitled to. However, you should consult with a workers’ compensation attorney first.

The appeals process entails a complex set of evidence and procedures. Because this particular situation is still relatively new, it’s extremely vital to have an experienced attorney on your side if you’ve made a claim for COVID-19. In California, workers’ compensation attorneys are paid a small portion of the benefits they obtain for you, and most will provide a free first consultation—which may be conducted over the phone or through videoconference.

Meanwhile, if you’re out of work due to COVID-19, you have additional alternatives, such as paid leave under California’s short-term disability insurance program and California’s 2021 COVID-19 Supplemental Paid Sick Leave, available through the State, for those working for employers with more than 25 employees.

The bottom line is this: this is a complicated situation but there is a simple solution for you – contact a workers’ compensation attorney. You can do so by calling DLC Law at (626) 285-8815

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