Over Half Of Hawaii’s Workers’ Comp COVID-19 Claims Are Initially Denied
Coronavirus-related claims are being denied at higher rates than other claims because it’s hard to prove whether an employee caught the virus at work.
More than 400 Hawaii workers have filed workers’ compensation claims related to COVID-19 since the pandemic started in Hawaii in February.
But more than 55% — 230 out of 425 — were initially denied pending investigations, according to the state Department of Labor and Industrial Relations.
Bill Kunstman, spokesman for DLIR, said typically fewer than 10% of workers’ comp claims are denied pending investigations. Employers and insurance carriers have the option to request investigations as part of their due process rights, he explained.
The initial denial rate is much higher for COVID-19-related cases in part because employers and insurance companies want to investigate where the employee may have caught the virus, Kunstman said.
“When somebody breaks their leg at work it’s pretty difficult for somebody to deny that that occurred at work. A virus is a little bit different,” he said.
Claims that are initially denied pending investigation may still eventually be approved if employers cannot find any evidence contradicting workers’ claims. But the initial denials may delay compensation, making it harder for sick or injured workers to afford medical care and make ends meet.
Nationally, workers have struggled to prove that COVID-19 is qualified as a workplace injury, according to
Every state has a worker’s compensation system, Kunstman said. The idea is that if a worker gets sick or injured on the job, employers will cover two-thirds of their income and any medical costs. The administrative process is intended to avoid costly litigation.
It doesn’t always work. Civil Beat previously reported that many workers wait years to receive compensation, some descending into homelessness as their claims are investigated and denied.
While have amended their laws to make it easier for workers who test positive for COVID-19 to obtain workers’ compensation, Hawaii isn’t among them.
Kunstman said in the first couple of months of the pandemic, employers and insurance carriers were automatically approving coronavirus-related claims, but that the trend reversed over the summer as the pandemic sped up and claims grew.
Just one coronavirus-related claim was filed in February. That jumped to 31 in March. In August, more than 232 claims were filed.
“The employers started taking a look at, OK, this person is claiming they got COVID here on the job, is there anybody in the house or family that has COVID before they got COVID?” he said. “Because of the nature of the illness, I think employers are doing some due diligence in order to make sure or to be more assured that this likely did happen at work.”
Coronavirus is mainly caught through airborne respiratory droplets, which can make it hard to prove where a worker got sick.
“We had a lot of inquiries from insurance carriers trying to get us to draw bright lines of what we would consider to be coronavirus-related illnesses,” he said. “Our response was, we have to do it on a case by case basis.”
Between February and October, Kunstman said the bulk of claims, 166, were filed in the health care and social assistance industries. Just 17 were filed in the accommodations and food service industry.
Over that same time period, 82 claims were filed by government employees, and 54 claims were filed in the financial industry. Manufacturing had 39 claims and transportation and warehousing had 29 claims.
Civil Beat requested the names of employers and carriers involved in the proceedings but Kunstman said the agency wouldn’t be able to provide them until next week.
Attorney Dennis Chang said he’s been surprised by how few inquiries he’s gotten regarding COVID-19. He doesn’t represent any clients with coronavirus and doesn’t know of any other attorneys who do in Hawaii’s small community of worker’s comp attorneys.
Kunstman said he couldn’t provide data on how many claimants are represented by attorneys.
Chang said it makes sense that employers would want to investigate coronavirus-related claims, but noted the high initial denial rate raises concerns about cases being left in limbo.
“Two hundred is outrageous,” he said.
