Case Study: Flexibility Offered by Texas Injury Benefit Plan Empowers Employer to Act
Years into the COVID-19 pandemic, new strains and waves of illness continue to result in employees claiming they may have possibly contracted COVID in the course and scope of their employment. But as is the case under Texas workers’ compensation programs, most COVID claims are not covered under Texas injury benefit programs. Why is this the case?
First, most employees readily admit they are not sure where they contracted the virus given that they and their families have many potential sources of exposure outside of work. Especially with highly contagious strains such as omicron, the process of delineating the point of exposure can be extremely difficult. Second, injury benefit plans are in part written to mirror the terms of the client’s excess insurance policy and, in most of these policies, the occupational disease definition excludes coverage for ordinary diseases of life to which the general public is exposed. Given its pandemic status, COVID is now considered an ordinary disease of life.
Where does this leave employers whose employees may have contracted COVID at work?
Over its many years helping clients get the best outcomes for employees injured on the job, PartnerSource has learned the value of the flexibility in Texas injury benefit programs, which allow clients the opportunity to take care of employees whose careers have put them in harm’s way, and have helped clients apply that flexibility when needed.
Recently, a PartnerSource client in the healthcare industry was presented with a benefit claim for COVID on behalf of an employee serving as a home health aide for a disabled patient. After interviewing the employee, performing contact tracing and carefully reviewing the timeline, the client determined that in all probability the employee had in fact contracted COVID in the course and scope of employment. The employee’s job put them in close contact with the patient for eight hours a day and the client’s investigation uncovered that not only had the patient tested positive for COVID the week prior to the employee, but there were also a number of other family members in the patient’s household that had also recently tested positive. The employee had contact with some of those family members given that the patient was being cared for in their home.
Although the client’s plan contained the occupational disease exclusion, the employer, based on the outcome of its investigation, wanted to take care of the employee. The client reached out to their PartnerSource team leader to determine next steps to leverage the flexibility afforded them, and PartnerSource was able to draft an out-of-plan settlement that paid for the employee’s wages during the period of time they had to self-quarantine, as well as for their medical treatment. These actions allowed the client to do what it felt was right under its own injury benefit plan.
The employee made a speedy recovery and was very appreciative of the concern shown by their employer, who leveraged the Texas option to create a pathway to healing for this employee.