Coronavirus FAQs for NJM Workers' Compensation Partners and Policyholders
NJM is here to help. We understand there are a number of questions and concerns regarding the novel coronavirus, COVID-19. These can range from coverage questions to continuing medical care for existing claims. The following information will guide you during this challenging time. If after reviewing these answers you believe your employee's injury or illness is eligible for workers' compensation, report it immediately. Log in or call 1-800-435-7656.The situation is evolving on a daily basis. If you have any questions that aren't answered here about a specific claim or workers' compensation policy, please contact us.
Workers' compensation insurance covers the medical expenses, wage loss, disability, and death benefits resulting from a job-related injury or illness. Although workers' compensation laws vary by state, an illness like COVID-19 or any other communicable disease must meet certain criteria to be considered compensable under the law. Specifically, the illness or disease must arise out of and in the course of employment. This means that the illness or disease must be caused by conditions that are peculiar to or incidental to the type of work.
In some states, first responders and healthcare workers who contract contagious diseases are presumed to qualify for workers' compensation benefits. As an example, a healthcare worker who is diagnosed with COVID-19 is presumed to be entitled to workers’ compensation if there is a confirmed exposure in the workplace. Employees in other occupations must demonstrate that their illness is related to that industry or occupation.
In most cases, the answer to this question is no. Workers' compensation insurance covers the medical expenses, wage loss, disability, or death benefits resulting from a compensable work-related illness or injury. Therefore, workers' compensation does not cover preventative measures such as precautionary quarantine. However, quarantines by healthcare workers could be covered, depending on the state’s laws.
NJM will evaluate each claim and make decisions regarding medical treatment, testing, and indemnity payments on a case by case basis.
Also note, other programs may be available to employees impacted by COVID-19, such as private and state-sponsored temporary disability, state and federal unemployment insurance, and state or federal medical insurance. We recommend that you visit your state's Department of Labor website for further resources.
If, after reviewing this information, you think your employee is eligible for workers' compensation benefits, immediately report the claim. Log in or call 1-800-435-7656. Please indicate that the claim is related to COVID-19 in the accident description. This will alert NJM to escalate the claim investigation. Provide all known information relating to when, where, and how the worker was exposed to the virus. An NJM Claims Representative will contact will contact you to gather any additional information needed.
NJM has allocated resources to attend to existing workers' compensation claims. However, the services of medical providers and independent medical experts may be limited by your state's laws. We are monitoring the status of our medical provider partners in order to make needed adjustments to existing claims, including telehealth options. Understanding that injured workers may not be able to seek the curative treatment that will allow them to return to work, we will be flexible in continuing indemnity payments as appropriate to the individual claim.
We thank you in advance for your patience and understanding in these unprecedented times.