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.
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.
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%).
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.
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.
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.