No Delays Found in Medical Care for Workers’ Compensation Claimants During COVID

Despite potential obstacles posed by the coronavirus pandemic, injured workers experienced no meaningful delays in access to medical treatment under their employers’ workers’ compensation programs during the pandemic.

Research from the Workers’ Compensation Research Institute (WCRI) also shows that states have varied substantially in the percentage of their workers’ compensation claims that have been Covid-19 related.

“We found no change in pattern in the first treatment, and no change in the number of visits,” said economist Olesya Fomenko during WCRI’s recent annual conference in explaining the preliminary findings of her research. Fomenko analyzed data on Covid-19 paid claims from 27 states for the first two quarters of 2020 compared to 2019.

The number of days from injury to treatment in 2020 was largely unaffected for Covid and non-Covid medical claims, as was the number of medical visits per claim. There was no delay for evaluation and management services, emergency room services, physical therapy, or surgery.

That was true whether the claims originated in the first half of 2020 or were existing claims carried over from 2018 and 2019. In fact, there was a slight improvement in speed to surgery for 2019 claims carried into 2020.

Fomenko also observed that for non-Covid-19 claims, there was almost no change in the injury composition between 2020 and 2019 second quarters. In 2019, 22% were lacerations/contusions compared to about 21% in 2020. Also, 26% were strains in 2019 while 22% were in 2020.

State Variations

“We see a large variation across states in the prevalence of Covid-19 claims,” Fomenko said of her other major finding.

For all 27 states studied, the median was 6% of all claims being Covid-19 claims.

The share varied substantially state-by-state. The states with the highest percentages of Covid claims were Massachusetts at 42%, New Jersey at 34% and Connecticut 23%. States with the lowest percentages of Covid claims among their workers’ compensation claims included South Carolina at 1% along with Kansas (2%), and Texas, Arkansas and Nevada (3%).

Regarding the variations among states, Fomenko found influencing factors include how hard a state was hit by the pandemic, how high the state’s unemployment rate rose, and whether the state had a law presuming the virus was caught on-the-job or a system feature that favored payment.

“The prevalence of COVID-19 claims is associated with the spread of the virus at the time and the sates that were hit the hardest by the pandemic in the second quarter of 2020, such as Connecticut, New Jersey, and Massachusetts, also had some of the highest percentages of Covid-19 claims,” she noted.

Non-Covid Claims

All 27 states saw a drop in non-Covid workers’ compensation claims during the first half of 2020, ranging from 20% to 50%. A majority of states had a 30% or more drop in non-Covid claims from the second quarter 2019 to the second quarter 2020. The states with the biggest drop were Massachusetts at 50% and seven states with more than a 40% drop (New Jersey, Michigan, Connecticut, Louisiana, Illinois, Florida and Pennsylvania). The smallest drops were 20% in Kansas, 21% in Arkansas, and 25% in Tennessee and Arizona.

“Here is where we see the impact of the massive economic slowdown, stay-home policies, and switching to work from home on the volume of workers’ compensation claims,” she explained.

While the drop in non-Covid claims appears to track with states’ unemployment rates, it is not fully explained by the unemployment picture, according to Fomenko.

Covid claims from workers have been most prevalent in certain high risk services industries; in particular in the health care industry including assisted living facilities, hospitals and physician and dentist offices. More than 60% of Covid claims in the first and second quarters of 2020 were in health services as opposed to in construction, manufacturing, clerical, or other industries.

Again, the share of claims in the healthcare sector varied by state, with only 8% in South Carolina and 9% in Kansas to a high of 75% in Massachusetts, 68% in New Jersey and 67% in Connecticut. The median rate among states of Covid-19 claims from the health care industry was 34%.

“Covid-19 claims have a concentration in high risk services, more than 60% of all claims were happening among workers in high-risk services,” Fomenko stated. Lower risk services had another 30% of Covid claims. “So, service industries have majority of Covid-19 claims by the end of the second quarter 2020.”

States that had passed workers’ compensation laws that presumed a virus was a job-related event laws in the second quarter 2020—Wisconsin, Kentucky, California, Pennsylvania, Delaware, Minnesota Illinois, Michigan ad Connecticut — tended to have higher percentage of Covid-19 claims than states that did not. Massachusetts and New Jersey had other features of their workers’ comp systems that had similar effect.

The states in the WCRI study were Arkansas, Arizona, California, Connecticut, Delaware, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, North Carolina, New Jersey, New Mexico, Nevada, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and Wisconsin.

This article was first published in Insurance Journal.

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