As with any other injury/illness, a key question is did the worker contract it in the scope of employment?
The worker/facility would have the burden to show that the virus was sustained at work. In order to be compensable, there would have to be some evidence of exposure to a patient or coworker who had the virus. Under current conditions, if a patient at one of the insured’s facilities contracts the virus, and there are no reported cases elsewhere in the community, this tends to indicate that the virus was sustained while at work at the hospital. Compensability will be determined on a case by case basis.
Our recommendation is for insureds to alert THIE immediately if a COVID-19 case turns out to be present in their facility, and, if any hospital employee is claiming to have contracted the disease, to file a report of injury immediately so that THIE can make an appropriate investigation.
The Texas Department of Insurance has also created a web page providing state and federal resources for stakeholders in the Texas workers’ compensation system as it relates to Coronavirus (COVID-19).
https://www.tdi.texas.gov/wc/information/coronavirus.html
If you have any additional questions, please contact our VP of Claims, Ida Murguia or Claims Manager, Dolores Amador.