Getting Workers' Compensation Benefits in California for COVID-19

If you contracted COVID-19 because of your job in California, you no doubt want to know whether you can receive workers' compensation benefits, including payments for your medical care and lost income while you're recovering and can't work.

Normally, it's very difficult for most employees to get these benefits for an infectious disease, especially one that's widespread in the community. But thanks to a state law passed in response to the pandemic, it will be easier to qualify for workers' comp if you get COVID-19 while working:

• as a healthcare professional
• as a first responder, or
• at a worksite with a coronavirus outbreak.

Read on for more details about getting workers' comp for COVID-19 in California.

Special Workers' Comp Rules for Some Employees Who Get COVID-19

Senate Bill 1159, which the California governor signed into law on September 20, 2020, makes certain employees who contract COVID-19 eligible to collect workers' compensation benefits, including medical coverage.

The law creates a rebuttable presumption that when first responders, firefighters, peace officers, and health care workers contract COVID-19, it is assumed to be work-related unless it can be proven otherwise. That means that these employees are generally eligible for workers' comp benefits for COVID-19.

The law also establishes a rebuttable presumption that workers who test positive during an outbreak of COVID-19 at their workplace contracted the virus at work, and are thus eligible for workers' comp.

The new law is set to remain in effect until January 1, 2023.

First Responders, Healthcare Workers, and Other High-Risk Employees

When certain healthcare workers and first responders test positive for COVID-19 within 14 days after working at their employer's direction and place of employment, they'll be entitled to a presumption that the illness is work related. High-risk employees covered under this law include:

• active firefighters and peace 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 had no contact with a COVID-19 patient within the previous 14 days; and
• providers of in-home supportive services.

If you work in one of these occupations, the insurance company has only 30 days to deny your claim for COVID-19 (rather than the normal 90-day time limit), unless it discovers evidence after that point to challenge the presumption that your illness is covered by workers' comp.

When you qualify for this presumption, you must use up any sick leave benefits that have been made available in response to COVID-19 before you can start collecting temporary disability benefits. But if you don't have access to any coronavirus-related sick leave, the normal three-day waiting period for temporary disability won't apply. (Cal. Labor Code § 3212.87 (2021).)

Workers' Comp Coverage When Workplaces Have COVID-19 Outbreaks

Even if you don't qualify for the law that applies to healthcare workers and first responders, California will presume that you have a work-related illness when you get COVID-19 within 14 days of working at a job site that's experiencing an outbreak of the disease, as long as your employer has at least five employees. An outbreak means that, within a 14-day period, at least four out of 100 or fewer employees at your workplace have tested positive for COVID-19 (or 4% of the total if there are more than 100 employees at that site), or officials have closed the workplace because of the risk of infection.

The insurance company has 45 days to deny your claim. To overcome the presumption, your employer or its insurer may present evidence including proof of measures it took to reduce transmission of the coronavirus at the workplace, as well as your own risks of infection outside of work. (Although this isn't spelled out in the law, you should be aware that the insurance company may look at social media posts and other evidence that you or other household members have gone to restaurants, gyms, or other gatherings with a risk of exposure to the virus.)

As with high-risk employees, you will need to exhaust any available coronavirus-related sick leave before you can collect temporary disability benefits under this law. (Cal. Labor Code § 3212.88 (2021).)

Getting Workers' Comp If You Aren't Eligible for the COVID-19 Presumptions

If you don't work in the type of job or workplace covered by the presumptions described above, it's not impossible to qualify for workers' comp benefits for COVID-19. But it will be very difficult. Under a longstanding rule in California, workers' comp won't cover an infectious illness unless you can prove both that your job involves a special exposure hazard that's greater than the risk in the general public, and that you contracted the disease because of a specific, identifiable exposure at work.

How Does a Preexisting Condition Affect Workers' Comp Benefits for COVID-19 in California?

The California Supreme Court has long recognized that in order for an injury or illness to be covered by workers' compensation in California, the employee's job doesn't have to be the only reason the worker needs medical care or can't work. It simply must be one of the contributing causes. (See, for example, South Coast Framing, Inc. v. Workers' Comp. Appeals Bd., 61 Cal.4th 291 (2015).)

This rule usually applies to cases when an on-the-job injury aggravates a pre-existing condition that wasn't related to work. But in theory, at least, it might apply in the reverse situation—when a preexisting work-related condition makes a case of COVID-19 more severe, resulting in a greater need for medical treatment and a long recovery (or even death).

It's not clear how insurers and the state workers' compensation agency will apply the "contributing cause" rule to this scenario. But if you find yourself in this situation, it's possible you could get workers' comp benefits for all of your medical treatment and temporary disability (as well as death benefits for your survivors, in the awful event that you died from the disease), even if you couldn't show that you got COVID-19 at work.

Filing a Workers' Compensation Claim for COVID-19 and Getting Help

In order to start the process of applying for workers' comp benefits for COVID-19, you need to report your illness to your employer within 30 days after the date of injury. You also have to file a claim form. (Learn about how and when to file a workers' comp claim in California.) While the insurance company is deciding whether to approve or deny your claim, it must pay up to $10,000 for your medical bills. However, you'll need to follow the rules for selecting your treating doctor.

If your claim is denied, you have the right to appeal. You also may challenge the insurer's decisions if isn't paying all of the benefits you're entitled to receive. But you should probably speak with a workers' comp lawyer first. The appeals process involves complicated rules on evidence and procedure. And it's especially important to have an experienced attorney on your side when you've filed a claim for COVID-19, because the issue is still new and unsettled. Workers' comp lawyers in California receive only a limited percentage of the benefits they win for you, and most will offer a free initial consultation—which might be over the phone or by videoconference. (Learn more about working with a workers' comp attorney.)

Meanwhile, you have other options for getting immediate benefits when you're out of work due to COVID-19, including paid leave under California's short-term disability insurance program.