If you contracted COVID-19 because of your job in California—either as an essential worker or after returning to your workplace when shutdown orders were lifted—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. Because COVID-19 is a highly contagious disease that’s rampant in the community, you usually need to meet special requirements to prove that you got the illness because of exposure on the job, rather than in the rest of your life.
This article explains those rules, as well as the looser standards that apply if you got sick in the spring and early summer of 2020.
Workers’ comp may cover occupational diseases—illnesses caused by on-the-job exposure, typically to substances like coal dust or asbestos. Infectious illnesses aren’t usually considered occupational diseases, but there are exceptions. Under a longstanding rule in California, you may be able to get workers’ comp for an infectious illness if your job involves a special risk of exposure that’s greater than the risk in the general public. That could be difficult to prove for many workers in the case of a highly contagious disease that’s widespread in the community—as in the COVID-19 pandemic.
Certain categories of workers—especially first responders and healthcare workers who have direct contact with COVID-19 patients—will find it easier to show that their jobs entail a special hazard of exposure to the virus. But what if you work in a high-volume grocery store, a nursing home, as a bus driver, or in another job that involves sustained contact in close quarters with a lot of people who could be spreading the virus? If you could show that you faced a greater risk of exposure compared to the general public, you might qualify for workers’ comp.
Even with a high-risk job, however, you normally need medical evidence that you contracted COVID-19 on the job—typically in the form of a doctor’s opinion that, “more likely than not,” you got sick because of a specific exposure or incident at work. Here again, it could be difficult to get that evidence—which is why California loosened the requirements, at least temporarily.
In May 2020, California Governor Newsom signed an executive order that made it easier to qualify for workers’ comp if you got COVID-19 while you were working away from home, but only during a limited period of time during the state’s pandemic shutdown. If you were diagnosed or tested positive within two weeks after a day that you worked at your employer’s job site (on or after March 19, 2020), you’re entitled to a presumption that your illness is work-related unless your employer (or its insurer) proves that you didn’t contract COVID-19 at work.
The insurance company has only 30 days to deny your claim (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.
The governor’s executive order also eliminated the normal waiting period before temporary disability benefits begin for COVID-19. However, you won't start receiving these benefits until you use up any sick leave that’s available to you. Also, you need a doctor’s certification at regular intervals that you’re temporarily disabled.
The executive order applies to "dates of injury" from May 6 through July 5, 2020. Typically, the date of injury for an occupational disease is when you first needed medical treatment or couldn't work because of the illness or diagnosis, and you knew that it was because of your job. (For more information, see the California Division of Workers’ Compensation’s FAQs on Executive Order N-62-20.)
The California legislature is considering a few bills that would extend similar presumptions (either permanently or for a longer time period) to certain groups of employees, such as first responders and healthcare workers.
If you don’t qualify for a presumption, that doesn't meant you can't get workers' comp benefits for COVID-19. It just means that your claim will be considered under California's normal rules for occupational diseases (discussed above).
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.
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 benefits under California’s short-term disability insurance program and emergency paid leave under the federal Families First Coronavirus Response Act (if you qualify based on the size of your employer).