FOLIO

DWC Releases a New Round of Data Call Results on COVID-19 Claims

Jan 3, 2022 | by FOL

The Division of Workers’ Compensation (DWC) has released its latest update on COVID-19 data call results. The data call was issued on June 2, 2020 to assist DWC in determining the impact of COVID-19 on the Texas workers’ compensation system. The mandatory data call was issued to 74 selected insurance carriers.

​The DWC’s latest update is current as of December 2021.

Key Findings include:

COVID-19 claims: As of November 7, 2021, insurance carriers reported more than 61,000 COVID-19 claims and 371 fatalities to DWC. Nearly half of these claims (45%) and half of the fatalities (50%) involve first responders and correctional officers.

COVID-19 claims with benefits: In 2020 and the first half of 2021, slightly less than one-third of COVID-19 claims filed(31%) had medical or indemnity benefit payments associated with them.

Claims with positive test or diagnosis: Most claims (60%) involved injured employees who tested positive or were diagnosed with COVID -19.

Denials and disputes: Insurance carriers accepted half (50%) of COVID-19 positive test claims. Despite more than 16,500 denials of COVID-19 claims with positive tests or diagnoses, there were only 134 disputes filed with DWC as of November 7, 2021.

Benefits paid: Most of the benefits paid on COVID-19 claims were indemnity benefits (particularly employer salary continuation), compared to medical benefits.

Claims with post-COVID conditions: About one out of five claims that received professional or hospital/facility services received these services beyond one month post-injury.

​Additional finding reported by DWC include:

• • • ​The majority (60%) of the state’s COVID-19 cases were concentrated in 10 counties, and the majority (56%) of the state’s COVID-19 workers’ compensation claims were also concentrated in these same 10 counties. Those counties were Harris, Dallas, Tarrant, Bexar, El Paso, Travis, Collin, Fort Bend, Denton, and Hidalgo.
    • Nearly half (45%) of the COVID-19 claims involved first responders and correctional officers, and slightly more than half (52%) of claims were processed by the State of Texas and its political subdivisions acting as insurance carriers.
    • As of November 7, 2021, insurance carriers reported 371 COVID-19 fatal claims to DWC. Slightly less than half (42%) of these fatal workers’ compensation claims were concentrated in the same 10 counties where the most COVID-19 cases and claims were reported. Half (50%) of the COVID-19 fatal claims involved first responders and correctional officers and slightly more than half (55%) of fatal claims were processed by the State of Texas and its political subdivisions.
    • Slightly more than two-thirds (68%) of the fatal claims involved injured employees who were 50 or more years of age, and slightly more than three-quarters (78%) of the fatal claims involved males.
    • Tens of thousands of COVID-19 claims were reported during 2020 and in the first half of 2021, only some had medical or indemnity payments associated with them. This indicates that most of these claims were either “exposure-only” claims (the injured employee did not test positive for or was diagnosed with COVID-19), were denied by insurance carriers as not work-related, or were not severe enough to incur medical or indemnity benefit payments.
    • For the claims reported as of September 30, 2021, insurance carriers and employers paid about $48 million in indemnity benefits on COVID-19 claims, $25.4 million (53%) in employer salary continuation, $20.6 million (43%) in workers’ compensation income benefits, $1.6 million (3%) in death benefits, and $223,264 (<1%) in burial benefits.
    • For the claims reported to insurance carriers as of September 30, 2021, insurance carriers paid a total of $28.1 million in medical costs on COVID-19 claims, $22.1 million (79%) in hospital/facility services, $5.5 million (19%) in professional services, and $443,914 (2%) in pharmacy services.
    • To date, most of these costs have been paid by political subdivisions (69%), followed by commercial insurance carriers (26%), and the State of Texas (4%).
    • A small number of employees had adverse reactions to the vaccine, which resulted in a workers’ compensation claim. From December 15, 2020, through November 7, 2021, insurance carriers reported to DWC a total of 603 COVID-19 vaccine reaction claims. Most of the vaccine reaction claims were processed by political subdivisions (71%) followed by commercial carriers (27%), and the State of Texas (2%).