Ebola Virus Exposure and Disease Policy

Background

Labor & Industries has a limited coverage policy unique to work-related Ebola exposure and infection. The extraordinary nature of Ebola, with its high mortality rates and unclear remedies makes it a serious and urgent public health threat. The Ebola virus is highly contagious, there is a lack of post-exposure prophylaxis and treatment, and an exposed worker presents a potentially significant hazard to other workers.

Effective Date: November 1, 2014

Establishing the Diagnosis

Presence of infection is generally confirmed by a positive blood test (Polymerase Chain Reaction or PCR test). It takes approximately 12 hours to get the results of a PCR test. The Centers for Disease Control and Prevention provides the case definition.

Exposure without confirmation of disease transmission

Because of the potential lethality of the Ebola virus for an exposed individual, and Ebola’s potential to progress to a widespread outbreak to co-workers, L&I believes the best way to keep Washington workers safe is to support the Washington (WA) State Department of Health’s (DOH) and the CDC’s recommendations to restrict movement (e.g., quarantine) of individuals exposed to Ebola virus. Thus, this limited policy provides for allowing exposure-only claims when all of the following criteria are met.

Coverage criteria

Exposure-only claims must meet all the following criteria:

1. Work-relatedness of exposure as established by either a or b:
   1. The exposure is due to an occupational injury (e.g., a needle stick injury in relationship to treatment of a known Ebola infected patient), or
   2. The exposure is not due to an occupational injury, but arises from conditions that are distinctive to the job (e.g., a nurse working directly with an Ebola patient, an EMT responding to a patient with demonstrated Ebola infection; a worker exposed while travelling on an airline for business would not be covered because the exposure is not distinctive to the job)
2. Based on the criteria established by the WA DOH (or CDC if DOH is inapplicable), a public health officer, or a physician who, in consultation with the public health officer, has determined it is medically necessary to restrict the worker’s movement (e.g. quarantine), and
3. The worker is unable to work because of those restrictions, is not kept on salary by his/her employer, and no modified duty from the employer (e.g. telework) is available within the quarantine requirements.

When an exposure-only claim is accepted, payment is allowed for lost wages only during the quarantine period of up to 21 days (the virus incubation period, or maximum time between Ebola exposure and occurrence of symptoms). Appropriate, medically required testing and surveillance would also be covered. This is a time limited benefit. No benefits shall be paid after the quarantine period has ended unless the worker develops Ebola infection.

Exposure with evidence of disease transmission

A work-related and confirmed case of Ebola virus disease is a covered condition. Medical benefits, including hospitalization, will be covered according to L&I’s medical aid rules and fee schedule. In addition, since there is no FDA-approved therapy for Ebola virus disease, the L&I Director and Medical Director may use their authority granted under WAC 296-20-02850 to allow experimental medications and treatments currently being used to treat the Ebola virus. Approval of and payment for these medications and treatments will be authorized by L&I’s Office of the Medical Director on a case by case basis.