25K Virus-Linked Claims Filed with Texas Workers’ Comp Carriers Through June 30

As of Sept. 27, workers’ compensation insurance carriers in Texas had reported more than 25,000 COVID-19 claims and 103 fatalities to the state’s regulators. The numbers cover virus-related claims reported to insurers through June 30, 2020.

A report released by the Texas Department of Insurance, Division of Workers’ Compensation shows that around 22% more overall workers’ compensation claims were reported to DWC from January to August 2020 than during the same period in 2019.

The majority of the claims and fatalities specific to the COVID-19 pandemic involve first responders and correctional officers/prison workers, according to the Workers’ Compensation Research and Evaluation Group’s report: Covid-19 in the Texas Workers’ Compensation System. Most claimants were males under 40 years of age. About six-in-10 claims were processed by the State of Texas and its political subdivisions acting as insurance carriers.

The report is based on responses to a DWC data call of 66 selected workers’ compensation carriers in Texas. The information submitted by insurance carriers as of Sept. 27 is limited to benefits paid as of Oct. 8 on claims reported to insurance carriers as of June 30.

The DWC’s data call sought to gather detailed information on the number of claims filed as of June 30 that resulted in in a positive test or diagnosis, and whether those claims were accepted, denied or are under investigation.

Among the results are:

• Claims with positive test or diagnosis: 35% of claims involved injured employees who tested positive or were diagnosed with COVID-19.
• Denials and disputes: Insurance carriers accepted almost half (48%) of COVID-19 positive test claims. Despite more than 1,633 denials of COVID-19 claims with positive tests or diagnoses, there were only five disputes filed with DWC as of Sept. 27, 2020.
• Benefits paid: For COVID-19 claims, most of the benefits paid were indemnity benefits (particularly employer salary continuation), compared to medical benefits.
• COVID-19 claims by county, occupation, gender, age, and type of insurance carrier: 61 percent of the state’s COVID-19 cases were concentrated in 10 counties. Likewise, about 57% of the state’s COVID-19 workers’ compensation claims were concentrated in these same 10 counties. The 10 counties are Harris, Dallas, Tarrant, Bexar, Hidalgo, Travis, El Paso, Cameron, Fort Bend and Nueces.
• COVID-19 fatalities by county, occupation, gender, age, and type of insurance carrier: As of September 27, 2020, insurance carriers reported 103 COVID-19 fatal claims to DWC. As with COVID-19 cases and claims, more than half of fatal workers’ compensation claims (53%) were concentrated in the same 10 counties. Nearly half (44%) of the COVID-19 fatal claims involved first responders and correctional officers/prison workers and half of these claims were processed by the State of Texas and its political subdivisions. Slightly more than two-thirds (71%) of the fatal claims involved injured employees who were 50 or more years of age, and more than two-thirds (68%) of these fatal claims involved males.

DWC’s administrative data shows that as of Oct. 8, 2020, insurance carriers have paid a total of $4.44 million in medical costs on COVID-19 claims. Most of these payments were for hospital/facility services. These costs are likely to increase over time as claims mature, and include medical costs, like COVID- 19 testing, professional fees, hospital facility fees, and pharmacy costs, according to the report.

Source: TDI-DWC