Florida Division Of Workers' Compensation 2020 COVID-19 Report
JIMMY PATRONISFLORIDA’S CHIEF FINANCIAL OFFICERFlorida Division of Workers’ Compensation2020 COVID-19 ReportData Summary as of May 31, 2020Division of Workers’ Compensation’s MissionTo actively ensure the self-execution of the workers’ compensation system byeducating system participants of their rights and responsibilities; by leveraging datato deliver exceptional value; and by holding participants accountable for fulfillingtheir obligations.Florida Department of Financial ServicesDivision of Workers’ CompensationJune 2020
FL WC COVID-19 Report as of May 31, 2020IntroductionThe Department of Financial Services, Division of Workers’ Compensation (DWC) is pleased to provide thisreport on the effects of COVID-19 on Florida’s Workers’ Compensation System. The DWC will continue toupdate this report as new data are reported and analyzed.COVID-19 should be reviewed through the lenses of three key terms within the workers’ compensationlaw: accident, injury, and occupational disease. These terms are defined in subsections 440.02(1), (19), andsubsection 440.151(2), F.S., respectively.The data in this report is organized by Claim Frequency, Claim Costs & Characteristics, Coverage Information,and Telemedicine. Claim Frequency and Claim Costs & Characteristics are workers’ compensation claimmeasures, while the Coverage Information provides a unique insight on the potential economic impact due toCOVID-19. Telemedicine represents how health care providers and carriers may be adapting in the provision ofmedical treatment to injured workers.We hope you find the data informative and beneficial. If you would like to provide any feedback, please emailus at Workers.CompService@myfloridacfo.com.2 of 17
FL WC COVID-19 Report as of May 31, 2020Commonly Used Terms and Their Meanings DOA: Date of Accident FDOH: Florida Department of Health DWC: Division of Workers’ Compensation DWC-9 (Form DFS-F5-DWC-9): Health Insurance Claim Form (HCFA 1500 or CMS 150) filed by Health Care Providers(HCP) EAO: Bureau of Employee Assistance and Ombudsman Office HCP: Health Care Providers IW: Injured Worker PFB: Petition for Benefits SDTF: Special Disability Trust Fund SI: Self-InsurerNotes for the Reader The Florida workers’ compensation data is changing and maturing over time, so the following information maychange in future publications as more data matures and becomes available. The data used in this summary is notfully matured for the period of 1/1/2020 to 5/31/2020 and will change over time. Date range data are based on 1/1/2020 to 5/31/2020 for COVID-19 and 1/1/2019 to 5/31/2019 when makingcomparison to past performance. The data is valued as of 6/1/2020. COVID-19 indemnity claims are determined based on a combination of Cause of Injury Code 8300 and Nature ofInjury Code 8300 in conjunction with keywords reported in the accident description of the claim sent to the Divisionof Workers’ Compensation (DWC). Indemnity claims are grouped by the date of accident (DOA). The source for the medical billing data is based on the Health Provider Claim Form (DWC-09) bills reported to DWC. Telemedicine data is grouped by date of service and is based on DWC-09 paid bills filed with DWC that met acombination of telemedicine markers. This summary does not include Medical Only claims in any claim counts or benefits paid. The data for exemption applications is grouped by calendar year based on the date received by DWC.3 of 17
FL WC COVID-19 Report as of May 31, 2020 440.02, F.S., states that “Accident” means only an unexpected or unusual event or result that happens suddenly.Disability or death due to the accidental acceleration or aggravation of a venereal disease or of a disease due to thehabitual use of alcohol or controlled substances or narcotic drugs, or a disease that manifests itself in the fear of ordislike for an individual because of the individual’s race, color, religion, sex, national origin, age, or handicap is notan injury by accident arising out of the employment. Subject to s. 440.15(5), F.S., if a preexisting disease or anomalyis accelerated or aggravated by an accident arising out of and in the course of employment, only acceleration ofdeath or acceleration or aggravation of the preexisting condition reasonably attributable to the accident iscompensable, with respect to any compensation otherwise payable under this chapter.An injury or disease caused by exposure to a toxic substance, including, but not limited to, fungus or mold, is not aninjury by accident arising out of the employment unless there is clear and convincing evidence establishing thatexposure to the specific substance involved, at the levels to which the employee was exposed, can cause the injuryor disease sustained by the employee. 440.02(19), F.S., states that “Injury” means personal injury or death by accident arising out of and in the course ofemployment, and such diseases or infection as naturally or unavoidably result from such injury. Damage todentures, eyeglasses, prosthetic devices, and artificial limbs may be included in this definition only when thedamage is shown to be part of, or in conjunction with, an accident. This damage must specifically occur as the resultof an accident in the normal course of employment. 440.151(2), F.S., states that whenever used in this section the term “occupational disease” shall be construed tomean only a disease which is due to causes and conditions which are characteristic of and peculiar to a particulartrade, occupation, process, or employment, and to exclude all ordinary diseases of life to which the general public isexposed, unless the incidence of the disease is substantially higher in the particular trade, occupation, process, oremployment than for the general public. “Occupational disease” means only a disease for which there areepidemiological studies showing that exposure to the specific substance involved, at the levels to which theemployee was exposed, may cause the precise disease sustained by the employee.4 of 17
FL WC COVID-19 Report as of May 31, 2020Table of Contents1.Claim Frequency 6Number of COVID-19 Claims By DOA 6Number of COVID-19 Claims by DOA Compared as a Subset of All Claims 62.Claim Costs & Claim Characteristics 7Claim Count & Amount Paid 7COVID-19 Indemnity Claim Count by Insurer Type 7COVID-19 Partial & Total Denial Claim Counts 7COVID-19 Claims by County 8COVID-19 Injured Worker (IW) Claims 103.Coverage Information 13Exemption Applications Received 13Proof of Coverage Policy Cancellations & Renewals 14Proof of Coverage Policy Filings 14Proof of Coverage Active Policies 154.Telemedicine 16Telemedicine Bills 16Telemedicine Billing by HCP License Type 175 of 17
FL WC COVID-19 Report as of May 31, 20201. Claim FrequencyNumber of COVID-19 Claims By DOANumber of COVID-19 Claims by DOA Compared as a Subset of All Claims6 of 17
FL WC COVID-19 Report as of May 31, 20202. Claim Costs & Claim CharacteristicsClaim Count & Amount PaidJanuary 2020 to May 2020COVID-19Indemnity ClaimsAll Indemnity ClaimsIndemnityClaim CountCOVID-19 asPercentage of AllIndemnity ClaimsTotal Paid Benefits(Indemnity & Medical)COVID-19 Total PaidBenefits as aPercentage of Total Paid3,80715.0% 3,431,3422.9%25,449 118,023,159COVID-19 Indemnity Claim Count by Insurer TypeInsurer TypeCOVID-19 Indemnity Claim CountCOVID-19 Total Paid1,4188221,5673,807 856,484 721,127 1,853,732 3,431,342PrivateSelf-Insurer PrivateSelf-Insurer GovernmentalGrand TotalCOVID-19 Partial & Total Denial Claim CountsInsurer TypePrivateSelf-Insurer PrivateSelf-Insurer GovernmentalGrand TotalCOVID-19 Partial DenialCOVID-19 Total DenialCOVID-19 Total of All Denials10121237751757451,6957851877461,7187 of 17
FL WC COVID-19 Report as of May 31, 2020COVID-19 Claims by CountyCountyDadeBrowardPalm BeachNot harlotteCollierSaint oleSumterPascoGadsdenIndian RiverLakeSaint ksonMonroeNassauHighlandsCOVID-19 Claim CountCOVID-19 Benefits 222191816151515141312111099887 1,560,993 498,179 248,575 535,544 40,588 40,747 155,083 53,677 3,007 25,260 39,862 17,243 13,673 14,326 11,615 18,025 10,377 0 15,229 2,788 5,313 6,837 17,271 1,011 1,454 16,205 4,777 3,011 0 3,137 2,908 3,937 7,424 4,762 8,546 1,259 0ALL COVID-19 Cases for Florida(Per FDOH 273130301471223651635248701189251108761298 of 17
FL WC COVID-19 Report as of May 31, 2020CountyLibertyPutnamSanta d TotalCOVID-19 Claim CountCOVID-19 Benefits Paid6665555443222211111 2,895 5,153 2,210 1,910 1,344 2,938 10,412 3,171 1,003 1,760 0 3,575 0 1,276 0 0 651 402 03,807 3,431,342ALL COVID-19 Cases for Florida(Per FDOH 269575118251212301415198832256,1639 of 17
FL WC COVID-19 Report as of May 31, 2020COVID-19 Injured Worker (IW) ClaimsCOVID-19 Claims Consolidated by Occupation of Injured WorkersThe groupings are based on text descriptions and risk codes. The total paid benefits include indemnity & medicalbenefits.COVID-19 Claim Counts and Amount PaidBroad Group ofOccupationsAirlineHealth CareOffice WorkersProtective Services*Service IndustryGrand TotalCOVID-19IndemnityClaim Count571,7402341,4313453,807Percentage of AllCOVID-19Indemnity Claims1.5%45.7%6.1%37.6%9.1%COVID-19Indemnity ClaimTotal Paid Benefits 63,269.82 1,360,020.20 495,937.23 1,381,132.39 130,982.46 3,431,342.10Percentage ofCOVID-19Benefits Paid1.8%39.6%14.5%40.3%3.8%COVID-19 Compensable ClaimsBroad Group of OccupationsAirlineHealth CareOffice WorkersProtective Services*Service IndustryGrand TotalCOVID-19Compensable Claim Count221,200128650892,089Compensable COVID-19Total Paid 62,956 1,346,660 494,964 1,353,360 127,360 3,385,300COVID-19 Denied ClaimsBroad Group ofOccupationsAirlineHealth CareOffice WorkersProtective Services*Service IndustryGrand TotalCOVID-19Full DenialClaim Count355211047802551,695COVID-19Full DenialBenefits Paid 314 12,974 973 27,239 3,352 44,851COVID-19Partial DenialClaim CountCOVID-19Partial DenialBenefits Paid1921123 386 0 533 271 1,190*Protective services figures include first responders.10 of 17
FL WC COVID-19 Report as of May 31, 2020COVID-19 Claim Counts by Gender of IW Tiered Ages of IWThis table includes information for compensable and denied claims.Gender & Age RangeFemale16 to 1920 to 2930 to 3940 to 4950 to 5960 to 6970 plusno date of birthMale16 to 1920 to 2930 to 3940 to 4950 to 5960 to 6970 plusno date of birthNot Indicated20 to 2930 to 3940 to 4950 to 5960 to 69Grand TotalClaim 018131213,80711 of 17
FL WC COVID-19 Report as of May 31, 2020COVID-19 Employee Assistance & Ombudsman Office InteractionsThe Bureau of Employee Assistance and Ombudsman Office (EA0) informs injured workers about the workers’compensation law and assists them in informally resolving claim disputes. EAO teams conduct fact-finding reviews,analyze claim files, research case law, promote open communication between parties, and help parties tounderstand their statutory responsibilities.EAO has conducted 291 interactions with Florida’s workers’ compensation system participants relating to COVID-19.2020JanuaryFebruaryMarchAprilMayGrand TotalNumber of Interactions253886160291COVID-19 Petition for Benefits (PFB)EAO also assists stakeholders with guidance on the Petition for Benefits (PFB) process.DWC has identified that PFBs have been filed on four (4) claims: Compensable claim - 1 Denied claims - 3The percentage of PFB filed for all COVID-19 claims is 0.1%.12 of 17
FL WC COVID-19 Report as of May 31, 20203. Coverage InformationExemption Applications Received13 of 17
FL WC COVID-19 Report as of May 31, 2020Proof of Coverage Policy Cancellations & yFebruaryMarchAprilMayReinstatements Filed20197,2296,9707,2997,1316,993Cancellations Filed201916,40814,56013,26212,67314,964New Policies Filed201937,48528,54128,77326,32926,736Total Active nstatements Filed20208,3477,6018,4073,5182,351Cancellations Filed202018,01313,96013,2037,9578,844New Policies Filed202035,39827,26128,95431,28322,825Total Active of of Coverage Policy Filings14 of 17
FL WC COVID-19 Report as of May 31, 2020Proof of Coverage Active Policies15 of 17
FL WC COVID-19 Report as of May 31, 20204. TelemedicineTelemedicine Bills16 of 17
FL WC COVID-19 Report as of May 31, 2020Telemedicine Billing by HCP License TypeLicense TypeMedical DoctorPhysical TherapistOsteopathic PhysicianOut-of-State Health Care ProviderOccupational TherapistPhysician AssistantPsychologistLicensed Mental Health CounselorAdvanced Registered Nurse PractitionerPodiatric PhysicianLicensed Clinical Social Worker ProvisionalMedical Doctor Out-of-State Telehealth ProviderChiropractic PhysicianLicensed Marriage and Family TherapistMedical Doctor Area Critical NeedDentistMassage TherapistDietitian/NutritionistRegistered NurseGrand TotalBill 12,156Total Paid 657,842 353,332 70,652 84,263 34,373 21,843 45,781 29,291 12,241 14,184 6,223 3,951 893 827 170 123 50 190 68 1,336,29817 of 17
Indemnity Claims COVID-19 Indemnity Claim Total Paid Benefits Percentage of COVID-19 Benefits Paid Grand Total 3,807 COVID-19 Compensable Claims Broad Group of Occupations COVID-19 Compensable Claim Count Compensable COVID-19 Total Paid Airline 22 62,956 Health Care 1,200 1,346,660 Office Workers 128 494,964
The Workers' Compensation Act was enacted in 1915 to protect workers and outline the responsibilities of stakeholders in Pennsylvania's workers' compensation system. Today, more than 100 years later, the Depart - ment of Labor & Industry's Bureau of Workers' Compensation, the Workers' Compensation Appeal Board and
1. Virginia's Workers' Compensation System 1 2. Timeliness of the Workers' Compensation System 11 3. Fairness in the Workers' Compensation System 23 4. Appropriateness of Disease Presumptions 41 5. Establishing and Rebutting Virginia's Disease Presumptions 63 6. Preventing Fraudulent or Inaccurate Workers' 81 Compensation Benefits
You must file the DWC Form-005 if you do not have workers compensation insurance, or you have terminated your workers compensation insurance coverage. However, if your only employees are exempt from coverage under the Texas Workers Compensation Act (for example, certain domestic workers, and certain farm and ranch workers) you do not have to file.
History of Workers Compensation 1 . The Historic Compromise: A Trade-Off Between Employers and Employees 1 . Exceptions to the No Fault Rule 2 . Evolution of Workers Compensation in California 2 . Chapter 2. Organization of the Workers Compensation System within State Government 4 . California s Division of Workers Compensation \(DWC\) 5
a Workers' Compensation Claim for Compensation, which your Workers' Compensation attorney can assist you in filing. Can survivor benefits be denied or reduced? The same rules that make an employee eligible for Workers' Compensation benefits, apply in the case of a work-related injury that results in death. First, the employer must .
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Any reference to employers includes the workers’ compensation insurance carrier, Di-vision of Workers’ Compensation (Division) approved individual self-insured employer or group trusts, as the case may be. The workers’ compensation law applies to all employ-ers that have five or more employees.
