Legislation before the Governor of California would restructure the state’s approach to making workers compensation benefits available to employees who have been diagnosed with COVID-19. In early May of this year, the Governor of California issued a sweeping Emergency Order creating a rebuttable presumption that COVID-19 positive employees working outside of the home between March 19 and July 5 contracted the virus at work. At the time, California’s Workers Compensation Insurance Rating Bureau estimated the order would cost employers and their insurers $1.2 billion in medical care, disability payments and death benefits. On August 31, the California legislature passed an extension and restructuring of the presumption of compensability which now awaits the Governor’s signature. The legislation would: • Codify the presumption established by the emergency order for the period March 19 to July 5. • Extend the presumption of compensability for first responders and certain health care workers through 2022. • Limit the presumption of compensability for other employees working outside of the home to apply only if there has been an outbreak of COVID-19 at the workplace. Under the presumption rules for workplace outbreaks, an employer must report to its insurance company (or claims administrator if self-insured) once the employer becomes aware an employee has tested positive for COVID-19. The insurer will keep track of these reports to determine whether 4 or more employees at a specific workplace (or 4% of the workforce at the site, if greater) have tested positive over a rolling 14-day period. If that threshold has been met, the presumption of compensability arises with respect to employees testing positive for COVID-19 during the period of the outbreak and who worked at the location of the outbreak within the prior 14 days. The employer can rebut the presumption that an employee became infected with COVID-19 due to a workplace outbreak with evidence of protective measures put in place to reduce the potential transmission of COVID-19 at the worksite or evidence of the employee’s nonoccupational risks of COVID-19 infection.

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California Presumption of Compensability (SB-1159)
COVID-19 Workers Compensation Presumptions
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California Presumption of Compensability
Overview
January 1, 2023March 19, 2020 July 5, 2020
First Responder Presumption
Workplace Outbreak Presumption
General Presumption
Employees working away from their residences during this period
are presumed to have contracted COVID-19 at work. The employee
must have tested positive for the virus (not antibodies) within two
weeks of the last day working outside of the home during this
period. The employer has a limited period to rebut the presumption
with evidence COVID-19 was contracted away from the workplace.
The general presumption continues for first responders and heath
care workers including firefighters, police officers, EMTs, health
care providers providing direct care to COVID-19, custodial staff in
contact with COVID-19 patients, and home health care workers.
Compensation Entitlement
The employee is entitled to full hospital, surgical, medical treatment, disability indemnity,
and death benefits resulting from a compensable case of COVID-19.
If an employee is entitled to sick leave benefits specifically available for COVID-19 (i.e.,
under the Families First Coronavirus Response Act or Executive Order N-51-20), those
benefits must be used up before temporary total disability benefits are payable.
Employees working away from their residences during this period are
presumed to have contracted COVID-19 at work only if there has
been a COVID-19 outbreak at the workplace. The employee must
have tested positive for the virus (not antibodies) within 2 weeks of
last working at the site of the outbreak. See next page for details.
Codification of Executive Order N-62-20 covering
workplace exposure from March 19 – July 5 for
all employees working outside of the home.

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California Presumption of Compensability
Presumption of Infection from a Workplace Outbreak (effective though January 1, 2023)
Notification of Positive COVID-19 Tests
Within three business days after an employer learns an employee working outside of the
home has tested positive for COVID-19 (not including an antibody test), the employer
must notify its workers compensation claims administrator (e.g., its insurer):
• An employee has tested positive;
• The date the tested specimen was collected;
• The specific address of the employee’s workplace(s) for the 14 days prior to
the test; and
• The highest number of employees who reported to work at that location or
locations within the 45-day period preceding the employee’s last day of work
at the location(s).
For employees testing positive between July 6, 2020 and the date of the legislation, the employer has 30 days to make
notification to the claim administrator with respect to all locations where the employee worked from July 6, 2020.
Claims Administrator’s Determination of an Outbreak
The employer’s claims administrator uses the reported information to determine
whether an “outbreak” has occurred at the location(s). An outbreak has occurred if
either:
• At least 4 employees working at the location (or 4% of employees if greater)
have tested positive within a rolling 14-day period; or
• A health department or similar body has ordered the location closed due to
risk of COVID-19 infection.
Presumption of Compensability for Workplace Outbreaks
A rebuttable presumption of compensability arises for an employee that:
• Tests positive for COVID-19 within 2 weeks after working at the location of a workplace outbreak occurring on or after July 6, 2020; and
• The test was conducted during the period of a COVID-19 outbreak at that work location.
The presumption of compensability of COVID-19 infection from a workplace outbreak applies except in the case of:
• Employers with 5 or fewer employees; and
• First responders and certain health care workers (because the broader general presumption applies).
The presumption may be rebutted including through evidence of measures in place to reduce potential transmission of COVID-19 in the employee’s
workplace and evidence of an employee’s nonoccupational risks of COVID-19 infection.
Transitional Rule

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California Presumption of Compensability
WCRIB Projections of California COVID-19 Workers Compensation Costs
Accident Year
Projected Cost of WC Benefits
Assumptions
Hospitalizations Deaths Total
2020 $700 million $400 million $1.1 billion
• 12% of working age COVID-19 deaths and
hospitalizations result in a compensable claim
2021 $525 million $300 million $825 million
• Consistent number of compensable claims
• Improvement in treatment
2022 $230 million $130 million $360 million • Reduced number of compensable claims
Projected COVID-19 Claim Costs, August 12, 2020 WCIRB Governing Committee Meeting Presentation
Estimate for Period
March 19 – July 5, 2020
Projected Cost of WC Benefits
First Responders and
Care Workers
Others Working
of the Home
Total
Low-Range $300 million $300 million $600 million
Mid-Range $800 million $400 million $1.2 billion
High-Range $1.2 billion $800 million $2 billion
Evaluation of Cost Impact of N-62-20, May 2020 WCIRB .
It is unclear the extent to which this assumption
reflects SB-1159 or other presumption of
compensability.