WSIA

[From the Department of Labor & Industries, March 25, 2020]

Recently, we sent you a link to Workers’ Compensation Coronavirus Common Questions. Here are some answers to commonly asked questions about Self-Insurance. We plan to add these to the COVID-19 Resources soon.  We’ll continue to add more, and will share them with you.

We have fewer staff in the office due to the coronavirus outbreak response and the governor’s Stay Home, Stay Healthy order. If you call the main phone number for Self-Insurance (360-902-6901), you may get a voice-mail message instead of a person. We will check these messages regularly and return phone calls within 48 hours. Some of our outgoing mail may take a few extra days.

We encourage you to use Secure File Transfer (SFT) instead of sending paper files to us.  If you want to set up this service, just send a note to Bill Bailey.

In addition, we are temporarily unable to fulfill requests for CDs of claim files.

We appreciate your patience during this time.

Q:  If a self-insured employer pays a worker’s wages while the worker is quarantined due to a work-related exposure, is the employer required to provide a SIF-2 form and assistance with filing a claim?

A:  No. For an exposure-related quarantine that does not result in a positive COVID-19 diagnosis, a SIF-2 form does not have to be completed as long as the employer continues to pay their regular wages.

Q:  If a self-insured employer receives a Physician’s Initial Report (PIR) for a quarantined worker who is not being tested for coronavirus and is still paid their regular wages, are they required to provide a SIF-2 form and assistance with filing a claim?

A:  Yes. If a PIR is received, a SIF-2 form should be filed. Allowance should be requested if the criteria are met (see Workers’ Compensation Coverage and Coronavirus Common Questions).

Q:  If a self-insured employer receives a PIR for a quarantined worker and coronavirus testing (or results) are pending, can the PIR/SIF-2 form be held until there are test results?

A:  No. If an employer receives a PIR, a SIF-2 form should be filed requesting allowance if the allowance criteria are met. This is an allowable claim for the quarantine period even if the worker tests negative and the employer is paying the worker their regular wages.

Q:  If a worker is diagnosed with COVID-19 and the allowance criteria are met, should a claim be submitted for allowance?

A:  Yes. However, if a worker is diagnosed with COVID-19 and the employer or third-party administrator (TPA) believe the criteria for allowance are not met, a claim should be submitted with a request for denial.

Q:  If a self-insured employer pays a worker’s wages while the worker is quarantined and tested for COVID-19, and the worker receives negative test results, should a claim be submitted for denial?

A:  No. If the employer paid the worker their regular salary during the quarantine period and the worker receives negative test results, no further action is needed.

Q:  If a self-insured employer doesn’t pay a worker’s wages while the worker is quarantined due to a work-related exposure, is the employer required to pay time-loss for the quarantine period?

A:  Yes. If the employer does not pay the worker their regular salary, the employer must pay time-loss to the worker for the quarantine period, up to 14 days. And, the employer is required to provide a SIF-2 form and assistance with filing a claim.

Q:  If a worker doesn’t meet the criteria for work-related exposure, is the self-insured employer required to pay the worker time-loss or their regular salary during the quarantine period?

1. No. If the exposure is not work-related and a worker is quarantined, then the employer is not required to pay time-loss to the worker; however, the employer may consider allowing the use of other paid leave to promote health and safety.

Q:  Are COVID-19 claims considered an injury or occupational disease?

A:  COVID-19 claims are considered occupational disease exposures. The date of manifestation (DOM) is the first day of quarantine or the diagnosis date, whichever comes first.

Q:  In the Workers’ Compensation Coverage and Coronavirus Common Questions, a worker must be quarantined by a public health officer or physician. As a self-insured employer, I’m having trouble obtaining that documentation. What should I do?

A:  Benefits for the 14-day quarantine period should be paid without delay. Documentation from a public health officer or physician may be obtained after payment has been made. If a worker self-quarantines, and during the 14-day quarantine period the worker is informed by a public health official or physician that the quarantine was appropriate, the worker is eligible to receive compensation for the entire quarantine period. As with all wage replacement benefits under the Industrial Insurance Act, the first three days are not paid unless the worker is medically required to remain off work on the 14^th day following exposure.