While SB 1159 provides a rebuttable presumption for employees who test positive for COVID-19, the claims administrator still has a duty to complete the initial investigation portion of the claim. This includes, but is not limited to, the initial three point contacts in which information is gathered pertaining to the alleged claim of injury. A rebuttable presumption does not waive the employer’s right or obligation to bypass the initial fact gathering piece of claim. This portion should be handled in the same manner as all non-presumptive and other presumptive claims of injury. An example of this may be simply verifying that there was a work-place exposure, contact exposure, last day worked, date of first symptoms, date of testing, etc. In many cases with law enforcement, there may not be a direct known exposure, however the questions still need to be asked in order for the claims administrator to do their due diligence in the claim discovery process.
For claims that fall within Section 4 of SB 1159, it is imperative that the claims administrator document if an outbreak occurred relating to the period of time surrounding the employee’s last day worked, as well as their date of testing. Note that this must be tracked and verified both 14 days prior and 14 days forward to determine if there was an “outbreak”, as this is a key factor in the compensability determination.
For existing claims filed post the Executive Order period, it is imperative that these claims be re-reviewed to determine if a previously denied claim meets the newly enacted criterion and presumption qualifiers and should now be accepted. The intent of the legislature is not to overturn previously accepted claims. Careful attention should be made to the compensability determination date, as many were defaulting to the 90 day delay period pursuant to LC 5402; however claim determinations are to be made within 30 days (for those classifications noted in Section 2) and 45 days (for all other employees).