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Snapshot: An Overview of COVID-19 Claims in the Texas Workers' Compensation System

Workers’ Compensation Research and Evaluation Group

The emergence of COVID-19 in early 2020 has affected business operations and created new concerns about liability for COVID-19 workers’ compensation claims. Due to these concerns, oversight of COVID-19 claims became crucial for the Texas Division of Workers’ Compensation (DWC) to better understand the impact of COVID-19 on the state’s workers’ compensation system.

This report provides ongoing information on COVID-19 claims, including a breakdown of claims by reported month, claimants’ demographics, residence/location, occupation, industry, and insurance carrier. It also provides statistics on claims that insurance carriers received, accepted, or denied, as well as indemnity or medical benefits paid on claims.

Read the full report.

Published: November 2022 by the Workers' Compensation Research & Evaluation Group.

Claims with fatalities: 459; Claims with positive test or diagnosis: 68%; Percent of these claims denied: 59%; Percent of these claims accepted: 39%; First responder reprocessed claims: Accepted 62%, Denied 38%.
The greatest number of COVID-19 cases in Texas were reported in January 2022, followed by January 2021, December 2020, August 2021, and September 2021. As Figure 1 shows, half of all COVID-19 cases in Texas were reported during these five months of the pandemic.

Similarly, the greatest number of COVID-19 claims in the Texas workers’ compensation system were reported in January 2022, followed by July 2020, December 2020, January 2021, and August 2021. Less than half of the claims (42%) were reported in these five months of the pandemic. Figure 1. Monthly trends of COVID-19 cases in Texas and COVID-19 claims in the Texas workers' compensation system

The greatest number of COVID-19 fatal cases in Texas were reported in January 2021, followed by September 2021, December 2020, August 2021, and July 2020. Nearly half of the fatal cases (44%) were reported in these five months of the pandemic.

Similarly, the greatest reported number of COVID-19 fatal claims in the Texas workers’ compensation system was in September 2021, followed by July 2020, August 2021, January 2021, and August 2020. Two out of five fatal claims (40%) were reported during those months.

Figure 2. Monthly trends of COVID-19 fatal cases in Texas and COVID-19 fatal claims in the Texas workers' compensation system

More than half of COVID-19 claims (51%) and COVID-19 fatal claims (55%) involved first responders and correctional officers. These statistics indicate that the proportion of first responder and correctional officer COVID-19 fatal claims were higher than that of the proportion of COVID-19 claims. On the contrary, a lower proportion of health/social assistance workers had COVID-19 fatal claims (9%) than COVID-19 claims (16%).

Figure 3. COVID-19 claims by occupation Figure 4. COVID-19 fatal claims by occupation

Results of the data call for claims reported to insurers showed that 68% of COVID-19 claims involved an injured employee who tested positive or was diagnosed with COVID-19. Among these positive test claims, more than half (59%) were accepted as work-related by insurance carriers, less than half (39%) were denied, and 2% were still under investigation. These statistics vary across types of insurance carriers. Commercial carriers reported the highest number (18,358) and rate (74%) of COVID-19 denials. Despite more than 22,000 denied COVID-19 claims, there were only 207 claim disputes filed with DWC.

Table 3. COVID-19 claims, positive text claims, and claim disposition

A total of $121.6 million in benefits was paid on these claims. Slightly more than one third (35%) of COVID-19 claims received medical, indemnity, or both types of benefits, and nearly two thirds (65%) of the claims were “exposure-only”1 for which insurance carriers did not pay any benefits.

Table 4. COVID-19 claims based on benefit types

Senate Bill (SB) 22, 87th Legislature, Regular Session, (2021), created a rebuttable presumption that a COVID-19 death or injury is work-related for certain first responders, including detention officers, custodial officers, firefighters, peace officers, and emergency medical technicians for claims filed on or after June 14, 2021. SB 22 also provided a process for certain first responders whose benefits were denied to request that the insurance carrier reprocess the claim. After passage of that bill, DWC started receiving PLN-15s, Notice of Request to Reprocess a COVID-19 Claim Subject to Texas Government Code Section 607.0545.

Table 6. Number of first responder claims initially denied, then accepted or denied after reconsideration

For more information, contact: WCResearch@tdi.texas.gov

Last updated: 2/22/2024