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Newly extended presumption that COVID-19 illness or death for workers is an occupational injury takes effect in California: what conditions apply?

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A new Bill in California confirms and extends the presumption that illness or death related to COVID-19 is an occupational illness. This article examines the conditions for the presumption to apply and the circumstances in which employers will be able to dispute it.

On 17 September 2020, California Governor Gavin Newsom signed into law a bill (Senate Bill 1159, the ‘Bill’) which modifies and extends a previous order (Executive Order N-62-20) that created a disputable workers’ compensation presumption that illness or death related to COVID-19 is an occupational injury and therefore eligible for benefits. The statute takes effect immediately and remains in effect through 1 January 2023.

‘Disputable’ presumption

The presumption is ‘disputable’ in that an employer may dispute the presumption with evidence such as evidence of:

  • measures in place to reduce potential transmission of COVID-19 in the employee’s place of employment; and/or
  • the employee’s non-occupational risks of COVID-19 infection.

There are two criteria for the presumption (pursuant to Labor Code sections 3212.87 and 3212.88). For employees meeting the criteria for the presumption under Section 3212.87 (the First Responders and Health Care Workers presumption), the employer will have up to 30 days to investigate and decide whether to accept or deny the claim. If the employer fails to reject the claim within 30 days, the injury or illness is presumed compensable, and the employer can then rebut that presumption only with evidence discovered after the 30-day period. The corresponding time period for employees who otherwise meet the criteria for the presumption (set out in Labor Code s3212.88) is 45 days.

Covered period

The presumption exists for employees who suffer illness or death resulting from COVID-19 on or after 6 July 2020 through 1 January 2023.

Who is covered?

The presumption under Section 3212.88 applies to all employees:

  • who test positive during an outbreak at the employee’s specific place of employment; and
  • whose employer has five or more employees.

The term ‘injury’ includes illness or death resulting from COVID-19, and all of the following conditions must exist for the presumption to apply:

  • The employee tests positive for COVID-19 within 14 days after a day that the employee performed labour or services at the employee’s place of employment at the employer’s direction.
  • The day on which the employee performed labour or services at the employee’s place of employment at the employer’s direction was on or after 6 July 2020. The date of injury shall be the last date the employee performed labor or services at the employee’s place of employment at the employer’s direction prior to the positive test.
  • The employee’s positive test occurred during a period of an outbreak at the employee’s specific place of employment.

What is an ‘outbreak’?

An ‘outbreak’ exists if, within 14 calendar days, one of the following occurs at a specific place of employment:

  • If the employer has 100 employees or fewer at a specific place of employment, four employees test positive for COVID-19.
  • If the employer has more than 100 employees at a specific place of employment, 4% of the number of employees who reported to the specific place of employment test positive for COVID-19.
  • A specific place of employment is ordered to close by a local public health department, the State Department of Public Health, the Division of Occupational Safety and Health, or a school superintendent due to a risk of infection with COVID-19.

What is a ‘specific place of employment’?

The Bill defines a ‘specific place of employment’ as ‘the building, store, facility, or agricultural field where an employee performs work at the employer’s direction.’ It explicitly excludes the employee’s home or residence, ‘unless the employee provides home health care services to another individual at the employee’s home or residence.’

What benefits are available to the employee?

The compensation includes ‘full hospital, surgical, medical treatment, disability indemnity, and death benefits.’ The Bill specifically waives the Department of Industrial Relations’ right to collect any death benefits for deceased employees with no dependents (Labor Code Section 4706.5).

Under the Bill, if an employee has paid sick leave benefits specifically available in response to COVID-19, those benefits must be used and exhausted before any temporary disability benefits. However, if an employee does not have those sick leave benefits, the employee must be provided temporary disability benefits from the date of disability without any waiting period.

To qualify for temporary disability, an employee must satisfy either of the following:

  • If the employee tests positive or is diagnosed with COVID-19 on or after 6 May 2020, the employee will be certified for temporary disability within the first 15 days after the initial diagnosis, and recertified for temporary disability every 15 days after that, for the first 45 days following diagnosis.
  • If the employee tested positive or was diagnosed with COVID-19 before 6 May 2020, the employee must have obtained a certification, no later than 21 May 2020, documenting the period for which the employee was temporarily disabled and unable to work. The employee will be recertified for temporary disability every 15 days after that, for the first 45 days following diagnosis.

Reporting requirements

When the employer knows or reasonably should know that an employee has tested positive for COVID-19, the employer must report to its claims administrator in writing via email or fax within three business days all of the following:

  • An employee has tested positive. For purposes of this reporting, the employer must not provide any personally identifiable information regarding the employee who tested positive for COVID-19 unless the employee asserts the infection is work related or has filed a claim form pursuant to s5401;
  • The date the employee tested positive, which is the date the specimen was collected for testing.
  • The address or addresses of the employee’s specific place of employment during the 14-day period preceding the date of the employee’s positive test.
  • The highest number of employees who reported to work at the employee’s specific place of employment in the 45-day period preceding the last day the employee worked at each specific place of employment.

Note that the Bill establishes a penalty of up to USD 10,000 for an employer ‘who intentionally submits false or misleading information or fails to submit information’ when reporting.

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