COVID-19 Frequently Asked Questions and More – 4/10/2020 Update

(April 10, 2020) As we move into the second month of the COVID-19 pandemic, there are some key issues, frequently asked questions, and insurance policy changes that are developing. We wanted to provide you with several that we feel are important. As always, reach out to us with questions, clarification or advice.

HEALTH INSURANCE:

• Many carriers are waiving cost share provisions for the testing and treatment of COVID-19. This means individuals are not responsible for copayments, deductibles, or coinsurance. Testing continues to be available only to those who exhibit symptoms.
• Telehealth is becoming very prevalent for non-emergency medical care. Many carriers are waiving copayments for this service.
• Pre-authorization for prescription medications may be extended for up to 90 days.
• Employees that are furloughed or have reduced hours may be allowed to remain on the group health plans if the employer continues to pay the premium.
• Special Enrollment Periods may be allowed for employees that initially waived coverage for a limited time period.

LOSS OF INCOME COVERAGE:

• This coverage is “triggered” by a direct physical loss, normally a property loss. Communicable Disease or Civil Authority closure caused by communicable disease is not normally a covered loss.
• Attorneys are challenging the language and intent of these policies.
• The American Property Casualty Insurance Association estimates the uncovered loss of income for businesses to be approximately $383 billion per month.
• The U.S. Government initially considered providing funding for this coverage, however, those talks have diminished.

WORKERS COMPENSATION:

• For COVID-19 to be considered compensable under Workers Compensation the exposure must BOTH arise out of the workers employment AND be in the scope and course of their employment when the exposure took place. Simply being exposed at work will not generally satisfy this two pronged compensability test.
• On April 7^th, Missouri Governor Parson announced that first responders (law enforcement, public safety officers, firefighters and emergency medical technicians) who contract disease or are quarantined due to exposure of COVID-19 will be covered under workers compensation as an occupational disease. This change in coverage definition does not apply if the exposure was not work related (by clear and convincing evidence).
• Some carriers are allowing workers to be reclassified if they have substantially changed their job duties such as working at home.
• All Conferences, Pre-Hearings, and Show Cause Dismissal Settings will be cancelled (and rescheduled) through May 29. Scheduled Mediations will still take place via teleconference. Most Scheduled Hearings will be continued. Questions can be addressed by your local Division of Work Comp Office.
• Many Workers Compensation Clinics are not seeing new patients or performing diagnostics. Some injuries can be addressed using telehealth services. Please contact our office or your carrier for guidance on injured worker treatment.

INSURANCE CLAIMS:

• Carriers are complying with CDC guidelines and are adjusting more claims using photos, teleconferencing and technology.
• If an on-site inspection is necessary, adjusters will normally wear personal protective equipment. Many property claims are still being adjusted if the damage is on the outside of a building.
• Auto claims are routinely being adjusted using virtual estimating with photos and working with body shops.

** All of the above are guidelines, each situation and insurance company needs to be consulted for policy language and procedures **

We are here to navigate these issues and more. We will proactively reach out to you on situations we are aware of, however, don’t hesitate to reach out to us. Our staff and our offices are fully operational using phone, email and video-conferencing. Please let us know how we can assist – we’re available to help.

With Appreciation,