Self-Insurance and Coronavirus (COVID-19) Common Questions

Is there a waiting period for payment of time-loss benefits?

No. There is no waiting period. All days except for the date the disease was contracted may be payable for claims that meet the presumption laws (RCW 51.32.181 and RCW 51.32.390). This includes the “first three days”. This is unique to claims filed as a result of public health emergencies involving infectious or contagious diseases.

Does the presumption apply to quarantine as a result of exposure?

Yes, for health care workers covered by RCW 51.32.390. The presumption for frontline workers covered under RCW 51.32.181 is only for contracting the disease.

Can a presumption of occupational disease be challenged?

Yes. Both laws have presumptive coverage which may be challenged if the employer can show that the worker did not contract the disease through their job. For health care workers, the standard of evidence to challenge presumptive coverage must be “clear and convincing.” For frontline workers, “preponderance” of evidence is the standard.

Can a worker file a claim for a reaction after being vaccinated for COVID-19?

Yes, a worker may file a claim, but there is no presumption of coverage.
Claims will be allowed for employees who have a reaction to the vaccine when it is required by the employer and/or by government order, rule, or law as a condition of employment. Other claims will be evaluated on a case-by-case basis.

A worker would like to postpone their independent medical examination (IME) and/or travel arrangements because of concerns about coronavirus. What do I do?

Contact your claim manager at least 5 business days before your appointment to find a solution. IMEs can be postponed in some cases if, for example, you are at high risk for serious illness from the virus or have recently been exposed to or contracted COVID-19.

Up-to-date CDC travel recommendations can be found here: https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html.

Is it possible for a claim to be allowed if it does not meet either of the presumptions?

Yes, it is possible. The following questions will be used to help determine if a claim will be allowed for a worker who is not in a job or at facility where exposure would be routinely expected:

• Was there an increased risk or greater likelihood of exposure or contracting the disease due to the worker’s job duties?
• If not for their job, would the worker have been exposed or contracted the condition?
• Can the worker identify a specific source or event during their employment that resulted in exposure to COVID-19?

When exposure to or contraction of the disease is incidental to the workplace or common to all employment, the claim will likely be denied.

If a self-insured employer receives a Physician's Initial Report (PIR) for a quarantined employee 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?

Yes. If a PIR is received, a SIF-2 form should be filed. The self-insured employer should request for the claim to be allowed if it meets the presumption or the criteria detailed above.

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

No. If a self-insured employer receives a PIR, a SIF-2 form should be filed. If the worker is a health care worker, claim allowance should be requested. For other workers the employer may request an interlocutory order -- a non-final order that is issued while the case is still pending -- until results from the testing are received.

If a self-insured employer pays an employee's wages while the employee is quarantined and tested for coronavirus, and the employee receives negative test results, should a claim be submitted for denial?

If the worker is health care worker, then the claim should be allowed. For other workers, if the employer paid the employee their regular salary during the quarantine period and the worker receives negative test results, no further action is needed.

If a self-insured employer doesn't pay an employee's wages while the employee is quarantined due to a work-related exposure, is the employer required to pay time-loss benefits for the quarantine period?

Yes, if the employee is a health care worker or if the employee meets the criteria. If the employer does not pay the employee their regular salary, the employer must pay time-loss benefits to the employee 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.

Are coronavirus-related claims considered an injury or occupational disease?

COVID-19 claims are considered occupational disease exposures. The date of manifestation is whichever occurs first of the following:

• The first missed work day due to symptoms;
• The day the worker was quarantined by a medical provider or public health official, or;
• The day the worker received a positive test result confirming contraction of the infectious or contagious disease.
What is the best way to contact L&I for more questions?

Call L&I's main phone number for self-insurance: 360-902-6901.

What's the best way to send information to L&I?

L&I encourages self-insured employers to use Secure File Transfer (SFT), instead of sending paper files. To set up this service, contact us.