$175,000 COVID-19 Workers’ Comp Claim Denied
September 14, 2021
In February 2021, an employee became infected with COVID-19. The initial assessment could not rule out the exposure was not work related and a workers’ compensation claim was filed. The claim, injury investigation, treatment oversite, communication records, and documentation were all managed by Employer’s Guardian.
The employee passed away from COVID-19 and his wife filed a workers’ compensation claim, alleging it was work-related. However, the employer had implemented a robust COVID-19 prevention program developed by EG that integrated with the Health and Safety Program also built and managed by EG. Employer’s Guardian had performed a thorough investigation into the activities of the employee prior to testing positive for COVID. The investigation uncovered evidence that the employee spent a substantial amount of time in a casino, days before his hospitalization. The investigation was documented and submitted to the insurance carrier along with the first report of injury. The insurance carrier determined that the exposure was not work related and denied the claim. The claim would have cost the carrier $175,000 to settle, which would have been passed back to the employer through increased insurance premiums for the next 3 policy periods.
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