Post Exposure Prophylaxis and Testing
Certain occupations are at increased risk of exposure to infectious disease due to the work environment, such as first responders, animal handlers, etc. Infectious diseases may be transmitted through a number of means, including but not limited to blood, saliva and other bodily fluids. If, in the course of employment, a worker is exposed to an infectious disease, rapid medical treatment may be required to prevent infection.
The Industrial Insurance Act (RCW 51.36.010, WAC 296-20-03005) allows the department or self-insured employer to pay for post-exposure prophylaxis (PEP) whenever an injury occurs (e.g., needle stick or laceration) and there is a potential exposure to an infectious disease.
It also allows for PEP in cases in which a work-related activity has resulted in probable exposure of the worker to an infectious disease, but with no injury. However, there must be a documented or probable work-related exposure in an occupation with a greater likelihood of contracting the disease on the job and there must be an employee/employer relationship.
Authorization of PEP does not bind the department or self-insured employer in the allowance of a claim should the worker contract the disease; a separate determination of such a claim is required.
Proper documentation of post-exposure testing and treatment may facilitate a claim allowance determination if the worker should later contract the disease.
Filing a Claim
Exposure with Injury
When a claim is filed for an exposure with injury (e.g., needle stick or animal bite) PEP may be authorized by the insurer through the following process:
- A claim must be filed within one (1) year from the date of the injury in order for the insurer to pay for PEP, testing and/or treatment.
- Following PEP the claim may close. Should the worker contract the disease following claim closure, a reopening application must be filed.
Exposure without Injury (Probable Exposure)
When a claim is filed for probable exposure (e.g., exposure to bodily fluid) PEP may be authorized by the insurer through the following process:
- A claim is filed documenting the probable exposure.
- The claim WILL BE REJECTED (there is no injury or evidence of disease at this point, only potential). HOWEVER, PEP may be authorized if there is a greater likelihood that the worker was exposed to the disease while working.
Criteria to consider when filing a claim for probable exposure:
- Was there a greater likelihood of contracting the condition due to the worker's occupation (e.g., first responder or health care worker)?
- If not for their job, would the worker have been exposed to the disease?
- Can the worker identify a specific source or event during performance of his or her employment that resulted in exposure?
If subsequent testing shows that the worker has contracted the disease:
- A new claim must be filed.
- Claim filing must occur within two (2) years from the date the worker receives written notice from a physician of the occupational disease diagnosis.
Adverse Reactions to Work-Related Vaccinations
The department or self-insured employer may pay for treatment related to adverse reactions caused by vaccinations only when:
- The vaccinations are mandated for employment and provided by the employer.
- A claim has been filed for the adverse reaction.
- A claim must be filed within one (1) year from the date of the mandatory vaccination.
Testing & PEP Regimens
The department or self-insured employer may pay for post exposure testing in accordance with the most recent U.S. Public Health Service (PHS) Guidelines and/or the Centers for Disease Control and Prevention (CDC) recommendations. Please see the CDC for the most current testing and treatment recommendations.
Please note, the department or self-insured employer will not pay for source testing under the claim. However, the Division of Occupational Safety & Health may require employers to pay for source testing under certain circumstances.
Post-exposure Prophylaxis Regimens
Appropriate post-exposure prophylaxis depends upon many factors unique to the patient and the exposure. The determination of whether to treat and which drug regimen to use is a medical decision made by the treating physician. The department or self-insured employer may pay for post-exposure prophylaxis in accordance with the most recent U.S. Public Health Service (PHS) Guidelines and/or the Centers for Disease Control and Prevention (CDC) recommendations. Please see the CDC for the most current testing and treatment recommendations.