The authors use a mixed-methods (including both qualitative and quantitative methods) approach to evaluate the overall effects of COVID-19 claims on the California workers' compensation system and on the payment of workers' compensation benefits. They also analyze the effects of the different presumptions for COVID-19 established by Senate Bill 1159 and describe patterns of COVID-19 claim filing and claim outcomes by industry and occupation.

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COVID-19 in the California Workers' Compensation System

A Study of COVID-19 Claims and Presumptions Under Senate Bill 1159

by Denise D. Quigley, Michael Dworsky, Nabeel Qureshi, Shannon Prier, Courtney A. Gidengil

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Research Questions

  1. How does COVID-19 claim volume vary across the presumptions created by SB 1159?
  2. How often are COVID-19 claims denied?
  3. How does COVID-19 claim volume vary across occupation and industry?
  4. What factors affect worker decisions to file COVID-19 claims?
  5. What are the issues for employers regarding providing paid sick leave for frontline workers or workers in a defined outbreak incident?
  6. Have the presumptions and reporting requirements created by SB 1159 led to administrative burdens?
  7. What costs are associated with indemnity, medical, and death benefits for COVID-19 claims?

With COVID-19 cases and deaths in California mounting in 2020, state policymakers enacted untested policies to cope with the most severe global pandemic in more than 100 years. One of those policies, Senate Bill 1159, facilitated access to workers' compensation (WC) benefits for select groups of workers. SB 1159 expanded access to WC benefits by establishing presumptions in the law that relieved certain workers — specifically frontline workers defined as health care and public safety employees, as well as workers whose job sites experienced a COVID-19 outbreak — of the burden of proving that the claimed injuries due to COVID-19 were related to work exposure. The authors use a mixed-methods (including both qualitative and quantitative methods) approach to evaluate the overall effects of COVID-19 claims on the California WC system and on the payment of WC benefits. They also analyze the effects of the different presumptions for COVID-19 established by SB 1159 and describe patterns of COVID-19 claim filing and claim outcomes by industry and occupation. The study found that COVID-19 claims accounted for 15 percent of all WC claims in the 18 months commencing at the beginning of 2020. COVID-19 claims were more likely to be initially denied than non–COVID-19 WC claims. The study also brought to light several challenges that the WC system experienced during the pandemic. For employers, these challenges primarily related to handling a large, fluctuating volume of claims within shortened time frames for claims investigations.

Key Findings

  • Between January 2020 and June 2021, 32 percent of statewide COVID-19 claims were by health care workers covered by the frontline presumption, 6 percent of such claims were filed by peace officers covered by the frontline presumption, and 4 percent of such claims were filed by firefighters covered by the frontline presumption.
  • The remaining 58 percent of COVID-19 claims were filed by workers who may have been covered by the outbreak presumption.
  • Factors affecting an employee's decision to file a COVID-19 claim included the need for more time off than provided by federal and state COVID-19 paid leave and/or coverage for high-cost medical care or hospitalization through WC benefits; knowledge of the requirements to file a COVID-19 claim and of exposure at work; a positive COVID-19 test; lack of fear of job loss or hesitancy about engaging in the WC system; confusion surrounding when to file a COVID-19 claim; and fear of income loss.
  • Employers most often noted that implementing the federal and state leave policies was easy, but some employers noted significant changes to their policies and practices.
  • COVID-19 claims were denied more often than non–COVID-19 claims, contributing to a much lower paid benefit cost per claim filed on COVID-19 claims.
  • In contrast to non–COVID-19 claims, which typically involve medical care, 80 percent of COVID-19 claims had no paid medical benefits. Yet COVID-19 claims were far more likely to involve the hospitalization or death of the worker, even when claims with no medical benefits are counted.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Background and Overview of Study

  • Chapter Three

    COVID-19 Claims Volumes, Denial Rates, and Benefit Receipt

  • Chapter Four

    Differences in COVID-19 Claim Outcomes Across Industries and Workers

  • Chapter Five

    COVID-19 Claims and Other COVID-19 Polices About Income Loss and Medical Care

  • Chapter Six

    Health and Safety Impacts of SB 1159

  • Chapter Seven

    Administration of COVID-19 Claims

  • Chapter Eight

    Costs of COVID-19 Claims

  • Chapter Nine

    Conclusions, Policy Implications and Future Research Priorities

  • Appendix A

    Summary of Literature Review Results

  • Appendix B

    Additional Information and Supplementary Results on Quantitative Analyses

Research conducted by

The research described in this report was prepared for the California Commission on Health and Safety and Workers' Compensation and conducted in the Justice Policy Program within RAND Social and Economic Well-Being.

This report is part of the RAND Corporation Research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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