by Mark Antonson - AVP Workers Compensation Administration
& Jose Reynoso - Director, WC Administration
May 27, 2020
Did you know that Matrix Absence Management administers workers’ compensation claims? We do and, in fact, workers’ comp was Matrix’s original line of business back in the day! Yet for all the COVID-19 coverage we have provided, this is a topic we haven’t covered yet.
If Matrix isn’t your workers’ comp claims administrator, I think this article will still be helpful – be sure your administrator is following the best practices outlined below.
Several states have enacted or by Executive Order adopted presumptions of compensability for Workers’ Compensation benefits for certain classifications of workers, typically healthcare workers and first responders. Some of these states have also expanded or are considering widening access to workers’ compensation coverage for COVID-19 beyond health care workers and first responders to include all workers labeled as essential. The provides regularly updated legislative and presumption activity by state as a useful reference.
Although administering claims in jurisdictions with presumptive rules places the burden on the employer to prove the virus was not contracted at work, it is still important to remember these are rebuttable presumptions and employers/claims administrators should still be diligent in investigating each claim thoroughly to overcome the presumption.
At Matrix, in conjunction with our defense counsel and Special Investigations Unit vendor, we have tailored our investigative practices involving COVID exposure claims to include gathering the appropriate information and unique circumstances of an employee’s exposure to ensure we have a full understanding of the exposure event in an expedited manner.
Continuity of Care
A lot of attention has been focused on the virus and whether it is work–related, what the cost impacts will be to the industry, what are the long term effects if any, etc. In addition, there is still a number of open claims for individuals without COVID who are impacted by the pandemic, such as those who require treatment for other work-related conditions or whose care has been interrupted or delayed as a result of the pandemic.
The importance of continuity of care is essential for employees to remain on the path to recovery and return to work. At the start of the shutdown, Matrix began coordinating with employee’s treatment providers to explore alternatives to in-person care via tele-medicine and tele-rehab. Staying active in providing alternatives for ongoing care has allowed us to maintain closing ratios at pre-COVID levels through April. We have seen delays in treatment for those requiring surgical procedures that were re-scheduled as they were deemed non-essential procedures.
Slowdown in Claims Resolution
Where we have seen a slowdown in moving claims to resolution are in jurisdictions whose Workers’ Compensation Hearing Divisions are only hearing certain types of cases or have rescheduled all hearings to later in the year. Although hearings in some states are delayed, it does provide us with the opportunity to reach settlement agreements amenable to both parties.
Return to Work
As the shutdown lightens, return to work in a number of industries – notably airlines, retail, restaurant, and hotel/hospitality – for both regular and modified/alternate work will be challenging. Using vocational counselors for outside job placement may be equally challenging given the number of employers who are not operating at capacity. Matrix continues to partner with our clients to find innovative return to work solutions based on our clients’ and their employees’ unique situations.
Impact on Disability Claims
Many short term and long term disability plans have an exclusion for claims covered by workers’ comp. Matrix’s disability claims examiners are well aware of this exclusion and which of our clients’ plans have such a provision, and will administer the disability claims accordingly.
Matrix can help!