Webinar: HR, Workers' Compensation & COVID-19 Live Recording Replay

Thank you all for joining us today. We have an overwhelming number of participants. We actually have a little over 630 people that registered. Unfortunately, we only have 500 spots for the, for the webinar, so anyone who didn't make it in will be able to, to get the replay. We will send the replay out to everyone that is is participating on the webinar with us today. I'm going to take a couple seconds to talk, just a few minutes, about why we're here today. You know, we are all battling the COVID-19. We are all, you know, had disruption in our life as COVID-19 has shown up on our doorsteps. What we wanted to do, and one of my goals with this with this webinar was to give us the ability as workers' comp professionals and HR professionals a venue to be able to disseminate information, to be able to, you know, dispel any myths that might be out there, to give an open forum for us to ask questions. So a couple things that's going to happen. Each one of our panelists is going to go through a set of questions that we sort of created. But as we go through the webinar, if you have questions yourself about what we are doing or about COVID-19 from a medical standpoint, from a legal standpoint, from an insurance carrier perspective, please go ahead and put your questions into the chat. And we will be glad to answer them as we're going. At the very end after the presentation, we will come back and answer questions that are in the chat. So that's our request from you. Please make this as active participation as you can. The second thing that I want to ask everyone is if you If there's a webinar that you would like us to do around COVID-19, we are also planning to do a webinar on telemedicine. If there are those types of topics that you'd like us to cover, we have a survey that will— you will automatically be sent to the survey at the end of this webinar. Please, we're asking you really diligently to fill out that survey, give us the feedback, Even if it's technical issues that we are having, please give us the feedback. Please tell us about some programs that you'd like us to bring forth because we in this time want to be an extreme resource for our community, the workers' comp community and the HR community, while we are going through this. So I still don't understand why I can't share screen. I'm looking at one other spot. This is my 5th webinar in the last couple of weeks, so I'm not a Zoom novice, but we will make this work. I'm going to not worry about it, and let's make it work. So let me introduce everyone to you. Our first panelist is Dr. Susan Nelson. She is an occupational physician with Physicians Health Center in Miami. She is a very well-known occupational physician and also practices telemedicine for the group in Miami. We also have Omar Perez, who is an attorney with Miller Kagan. Omar has been practicing for a number of years, and his specialty is workers' compensation with specific focus in Florida. We also have Natalie Torres, who is on the call with us. She is with WorkFinders, and they place injured employees at offsite jobs. During the normal course of events, if you had an employee who was injured and needed to find an alternative worksite, WorkFinders would do that. We also have Catherine Benavides with us, and Catherine is the CEO of IMO, Injury Management Organization. They are one of the leading managed care vendors in the state of Texas. She is also very versed in telehealth, which we will talk about, and we will talk about the varying things along the line. Because Dr. Nelson is seeing patients, I'm gonna go ahead and ask her to go first. So Dr. Nelson, some of the questions that we had from the group was, you know, what do we do about COVID-19? What are our— what should we know as employers? So can you fill us in on what we should know and what, what are the key things that you are seeing in the clinic on your end?

Okay, that's an interesting and very broad topic and on everybody's mind now, of course. Well, the first thing we do when the patients come in We take a temperature on everybody. If for workers, whatever they're coming in for, if they do have a fever, if they do have a cough, then we direct them out of the office and we tell them to call. We give them the 866 number of the Health Department to call to see what the next step would be or to call their physician. We've gotten a lot of different from different companies, different municipalities. What do we do? We have a patient with this. Well, we have some that are coming in for fitness for duty. We have some to the extreme of they came in, they coughed once. Now you're not allowed to cough, you're not allowed to sneeze because everyone gets a little bit excited. So they'll have the patient come in for fitness for duty. We'll see them, and then 99.9% of the time they're fine and they're ready to return to work. We are doing with one of the municipalities, we are doing with, with their corrections, with their police and fire, since they are all on the front lines and they definitely can be exposed, we are doing— they're having their testing on site, but we are sending in the tests and we're doing the workers' comp for that. We are processing the tests, and then once we get the results, we are calling the patient. There's a type of telemedicine, not video necessarily because it's not really necessary in this case, but we'll call them once we get the results. If they're negative, which most of them are, then we to the DWC. They're fine to return to work full duty and the case is closed. A couple that are— were positive, again, we direct them to the 866 number where they have to be quarantined for 14 days and then they're going to be retested and then again 24 hours after that. There's also the cases of— with another one of the municipalities, they had come in, they said they were they were tested somewhere else and they're waiting for the test result. What do they do? And that is also under workers' comp, so we're kind of working on that. So there are a lot of different scenarios, a lot of things that we never had to think about and never had to deal with, but we are.

Right, right. So what do you say to employers who are trying to figure out what to do next? What, what is the What's the plan that employers should deploy now as they're sending— especially for our municipal clients who are still actively out there working. What's your best practice for them?

For some of them, like the one of them I mentioned, they're pretty much testing everybody. If they're negative, fine. If not— Or if they are in contact, which is a CDC recommendation, if they are in contact with somebody who is known to be, uh, who does have the coronavirus, who's COVID-19 positive, then they have to, as the CDC recommends, they have to be quarantined for the 14 days. Not allowed to leave, not allowed to go to work for the 14 days. If they start having any symptoms If they have mild symptoms, mild cough or fever, that they can manage on their own. But if they have, you know, start having severe symptoms, shortness of breath or anything like that, they need to call their doctor or the CDC number and see what they recommend. It's not recommended to just walk into the emergency room, walk into the doctor. You need to call that number and see what they recommend. But a lot of employers, if they're patient has been— not that many people are traveling, but if they've been out of town, when they come back, 14 days automatic quarantine.

Okay, so beyond the quarantine side of it, tell me what do you say to employers who are challenging occupational exposure who may say, we're not sure how the employee got this. What is your— what are your steps when a person shows up and we're not sure where they got the exposure?

Well, they're not—

we—

they're not— they're not gonna necessarily show up at the office if they're having symptoms. If they're having fever, cough, or shortness of breath, they're not gonna— we recommend, obviously they don't, they don't come into the office and they're gonna have to be treated. But if it is, say, a firefighter, police officer, correction, pretty much those are going to be going under workers' compensation because they are the first responders. And it's— there's no way of knowing for sure. There's no 100% way of knowing how they got it. But for those type of positions, those types of jobs, you would have to say that yes, it was— it's something that is, is work-related. For other positions, there's, you know, it wouldn't really come under something that would be, would be work-related. If you're in— not that many offices are working, but if they work, if they're working at the airport, if they're working on Amazon, I don't think that in those jobs that they would necessarily say that that would be something that is work-related, because that would not be under their job description of something that they would get from work.

OK. So Dr. Nelson, in our panel, we have a question from one of our attendees. She wants to know, what is the number? What's the process that employers can take? I think you mentioned maybe calling the CDC. Can you go over that process again of if we have a suspected person who, who may have— be exhibiting the symptoms of COVID-19, who are we calling?

Okay, the 866 number.

There is an 866 number. We have it and we could provide it to anyone who needs it, but it's the hotline for the Florida Department of Health and where they're asking people to call in if they're needing testing to get further information on where to go and what the process is.

And they're excellent because we have— of course, if we get a positive result, we need to, we need to call and we need to report it and send them a copy of the result. And they, you know, answered within, you know, a minute. Very, very helpful. But if you call that, it's the Florida Department of Health, and then they will direct you to whatever county it is, either Miami-Dade County, Broward County, to call that number, and they will guide you specifically you tell them exactly, I'm having this, this, this. Yes, I think you should go here and be tested. I don't think you need to be tested. Even on their website, there's kind of like an interactive thing. You put what kind of symptoms you're having and you kind of plug it in and they'll direct you. They'll say what they recommend that they need to do. But if there's any questions, if you were in contact with somebody, if you are exhibiting, even if you have a low-grade fever, not all the, if you're not having all the symptoms and you're, even if you're not sure, you call that number and then they will, and they'll direct you. That is the, that's the best advice that I can give and tell the, the employers as well. We've had patients come in that did have fever and they were having, call, yeah, I'm having some shortness of breath. Okay, here, this is, this is what you need to do. Don't go to, don't go to work. Call this number and they'll direct you what you need to do.

Okay, all right, well, what we'll do is while we're going along, a couple people have asked for the number that you're using, um, so if we can get that, we'll—

I'll put it in.

You have it right here if you want us— we could just say it quick if anyone wants to write it down.

Sure, go ahead.

Okay, it's 866— hold on— 779-6121.

Okay, so it's 866-779-6121. And that's the Florida Department of Health.

Yes.

Yes.

Okay, got it. Okay, I put that into the chat. So there was a question from someone who is in healthcare, and they're asking— there was a question from someone who is a social worker, and she's working in the ER or working on the floor. If an employer— and I'm assuming that the question is coming from an employer— If the person is working on a floor and they're in healthcare and you guys are the provider for that office and they're working in healthcare and there's a suspected exposure, how are you handling that in your office, or are you?

Okay, what I would recommend in that case, the same thing. If they are in contact, Someone that's known, they need to quarantine themselves for the same thing, for the 14 days.

Okay. When is a 911 phone call— because one of the things that hasn't been answered by any of the things I've seen online is when is a 911 phone call necessary? I've seen in New York where people have been, you know, like the 911 number's going completely nuts. So if— and that's understandable because people are in crisis— but the question is, as an employer, um, when do I take the symptom as not just call the 800 number? At what point do I transition from call the 1-800 number?

If the patient is noticeably short of breath, having chest pain, high fever, feeling faint, passing out, obviously those are 911. I know people tend to abuse 911. "Oh, I was in contact with someone with COVID I have a little bit of a cough and fever." That's not what 911 is for, nor is the emergency room for. But for what we would normally call 911 for, I mean, it's no different. Specifically for this, it would be severe shortness of breath, extremely high fever, chest pain. Those would be the main reasons that you would call 911.

Okay.

We have a couple questions. There's one person that said one of their employees went to Cuba. He came back. He's trying to get a test. He can't get a test. So is testing available even in your office? How do you handle testing?

No, we don't do testing in our office. Testing is reserved only for certain cases. And they're recommending, like I said, if someone came back from traveling— actually, it was yesterday, the day before, we had someone who did come back from Cuba 14 days ago. He didn't go back to work. They sent him into the office for fitness for duty, and we found him to be fit for duty, but he was for 14 days He was quarantined because he came back from Cuba. There's no real— in that case, a test isn't really necessary, and probably they wouldn't do it because tests are, you know, they're really like masks now, are, you know, few and far between. So they're saved for, you know, for people who really need them.

Okay.

So we've talked about COVID-19. Let's talk about employees who were already injured in the system before COVID-19. So how are you managing to treat them? Are they still coming into the office? Are you using telemed? What's the process for treating people who have already been in the work comp system who do not have COVID-19, or people who are coming in right now today who don't have COVID-19?

Okay, we are still seeing patients in the office. Obviously it's, it's slower than it's been. But we are full into telemedicine. The app that we're using?

Yeah, I don't know, is it okay if we say the app we're using?

I don't know that it makes a difference. I don't think it does.

Okay, well anyway, we're using an excellent app that has video and telephone. They just have to download the app and we're setting that up and calling the patients. And so far we've done it a number of the telemedicine calls, and those are working out great because, you know, patients are afraid, and they have every reason to, and they don't want to, you know, they don't want to come out. They're heating, you know, stay at home, and they don't want to come in. So we're doing telemedicine, but we're still— we're having patients come in, come in as well. They're still coming in, new patients as well as follow-ups.

Okay.

And physical exams as well.

Okay.

What about physical therapy? Are you doing therapy?

We're doing physical therapy. Since that's more, you know, it's very close and more hands-on, obviously, the therapists are all wearing the personal protective equipment. They're wearing masks and gloves, and as always, we keep everything very, you know, very clean. Clean and sterile clean everything between every patient. So that's— but again, that's a lot slower than it's been as well. But they are offering— and I think this was even from before— done telehealth-wise as well. They're doing the therapy. They're showing them how to do the exercise and stuff that way. So even therapy can be done through that.

So one of the things that— That I— that there was a question here, a question about if the person— are you guys still doing pre-employment drug testing and drug screening if someone is hiring and they're wanting to go through the pre-employment process? Are we still doing pre-employment drug screenings? Are we still doing all of the normal things that would happen at the clinic?

Yes, yeah, we're doing everything normally. We do flight physicals, and we received an email from the FAA, and they said, even though some pilots, you know, are concerned about coming in, it says no, it still has to be something that's face-to-face. And some places are still hiring, which is great, and we're seeing pre-employment physicals and drug screens and DOT physicals every day. So yeah, we're still doing everything.

So the other question that was asked about specifically, PHCs, telemedicine. And Catherine is going to speak when we get to Catherine Benavides. She's going to speak about telemedicine in general and so on. But from a specific standpoint, Dr. Nelson, how is someone— if you were already treating someone and they can't come in, how are they getting notified that telemedicine is an option for them? How is that working?

OK, usually it's being offered to— I'm not sure if it's all employers now, but it's most. And I believe they're going to—

Zachary? Yeah, I'll just chime in since I'm assisting with setting up the telehealth program. We are— and again, this is all something new for us. We're just initiating it with our company. So we do have it. We are going to be sending out correspondence to our clients offering it. We initiated with our insurance carrier to let them know that it's an option for an adjuster or case manager to request it. We are also reaching out to these adjusters and case managers when we're scheduling the patient, letting them know this is an option so that when they're continuing the care, they can offer it to the employee and say, you know, we have—

they—

PHC now has the option to do telehealth. Would you like to? And then we're initiating it with our office as far as scheduling it directly with the patient. So we do have protocols in place. And as we formalize it more, we're going to send out more correspondence to our clients, letting them all know this is how you request the telehealth.

And for everybody on the call, I mean, we have— we workers' comp folks have been resistant to telemed. Telemed has always been in health care. They've been calling my aunt and checking on her in the nursing home for the last 9 years. So, you know. It's been out there. It's been a thing that's been used. But workers' comp has kicked and screamed, and we've been drug across the line. And Katherine will talk about that. And one of the things that Katherine, Max, and I will be doing in the next week is putting together a program on telehealth specifically. And Katherine will also be talking about, you know, we just don't set up telehealth. There's also metrics and matrixes that need to go with telehealth to make sure that it is effectively working. So Katherine will speak about that when she gets on. Dr. Nelson, is there anything else that you want to tell us before— I know you've got to go back to see patients, so is there anything else that you want to tell us before we move on to Omar?

Well, there's always, like with telehealth or also if patients want to wait in their car. When it's their turn, we're calling them to come in. So we're trying definitely as best we can to accommodate the patients. A lot of them are coming in with gloves and masks, and that's fine. Or some people are coming in with nothing, and they're perfectly fine. But we're definitely trying as best we can to accommodate any way and try to alleviate any fears that they may have. Because a lot of patients will come in, they hurt their shoulder, but of course they have COVID-19 questions. And we're trying to allay their fears a little bit.

Right, because we don't want them adding COVID-19 imaginary symptoms to their already workers' comp claim.

Just a little humor.

Oh, you know, everything's been, been very, very, very working very smoothly.

And yeah, okay, all right, great. Okay, Dr. Nelson, um, what we'll do is at the end of the presentation I'll ask you to come back if you have time, just in case there are more questions for Dr. Nelson. Um, there was— somebody said, um, Dr. Nelson, are you conservative in your approach to medical quarantine for all? Are you Are you feeling that medical quarantine for all, like how we're doing now, the stay-at-home thing, is effective to stop the spread of the virus?

Definitely, definitely, because staying away, staying, you know, further than 6 feet, that's how it's transmitted. So if you don't need to go out, of course, you know, some of us do, and that's great. But if you don't have to, there's no reason to be around other people. So I definitely think it's working. Okay, perfect, perfect. To work, yeah.

All right, great. Well, thank you so much, Dr. Nelson. Omar, you are up next. I've unmuted you. Thank you, Dr. Nelson.

Okay, thank you.

Okay, Omar, you've got the stage. You've got all the lawyering and all the things that, you know, I think your phone is probably burning up, Omar. So, uh, yeah, the phone is definitely burning up and so are the emails.

Um, I think that they're— the number one question that we are all receiving is, um, they're— we're constantly getting, my employee alleges they've contracted the coronavirus while at work, will this result in a compensable workers' compensation claim? And that is a question we are getting day in and day out. And as Dr. Nelson pointed out, the answer in great part is dependent upon the occupation of the employee. In Florida, if you are a first responder or a state employee who is required to interact with individuals who are infected or presumed to be infected with COVID-19, the answer is likely yes. And as of Monday, March 31st, our Florida Chief Financial Officer, Jimmy Patronis, directed the Division of Risk Management to provide workers' compensation coverage to state employees who are fighting COVID-19. And pursuant to this directive, the Division of Risk Management shall process workers' compensation claims submitted by frontline state employees have tested positive for COVID-19 unless the state of Florida can show by a preponderance of the evidence that a frontline state employee contracted the virus outside of his or her scope of employment as a state employee. And Dr. Nelson had referenced frontline state employees, and the directive specifically outlines who is included within that that terminology. And that includes first responders such as law enforcement officers, firefighters, emergency medical technicians, paramedics. It includes corrections officers whose official duties require physical presence in a state-operated detention facility. It includes state employees working in the healthcare field who require them to be in contact with individuals who are being tested for COVID-19, and it also includes child safety investigators who are responsible for performing welfare checks on behalf of minors. And lastly, it includes members of the Florida National Guard who've been called to duty in response to the virus. For all other employees in the private sector who alleged to be exposed to COVID-19 at work, a compensable workers' compensation claim is possible. But again, it would be dependent upon their occupation, and the analysis would be very fact-specific, and it would also require clear and convincing evidence. And, and go ahead.

And so, so for example, if, um, if I'm ringing up groceries in the local supermarket, um, what would, what would you say to an employer who calls you with that, you know, that call and says, you know, the employee says, I'm, I'm ringing up groceries and I now have COVID-19?

Yes, well, OSHA has actually, has a bulletin on categorizing occupations by risk of exposure in pandemics, and it goes from very high, high, to medium, to low. And an individual who would be exposed in a retail setting to high volume of traffic or high-frequency contact with the general population is actually at a medium exposure risk for contracting COVID-19. So in that case, it would require some further investigation, and I don't believe it would would be such a slam dunk for individuals who are in the high to very high risk category. And OSHA has already indicated that the occupations at high risk include— for being exposed to COVID-19 is obviously healthcare, death care, laboratories, airline operations, border protection, solid waste and wastewater management, as well as employees who are required to travel to areas where the virus is spreading. Um, and in the state of Florida, um, I believe that individuals will attempt to obtain compensability under 3 separate legal theories. Um, and the first of those theories would be under potentially occupational disease. Um, which is found under Florida Statute 440.151, subsection 2, or under a repetitive exposure theory, which is under the case of Festa versus Telefax, or exposure to a toxic substance, which is found under Florida Statute 440.02, subsection 1. So, and any of those potential theories, they can attempt, uh, to establish compensability of the exposure.

One of our attendees is asking a question, and so what his question is, greater risk. And so if a particular type of employment puts you at greater risk, what happens then? So greater risk may not also be on the list that anybody's created. Greater risk could be, in this case, let's say an employee is, you know, in close proximity to somebody else who is tested positive. Let's say— let's give that scenario. Then what?

Okay, well, if again under a greater risk category, you could potentially analyze it under an occupational disease.. And you would have under the state, under Florida, there's 6 specific elements that they must meet, and it's got to be proven by clear and convincing evidence, which is a pretty high degree standard. And/or they can attempt to meet it under the Festa test, which one of the elements is that it's a hazard greater than that to which the general public is exposed. So under those 2 theories, they can attempt to establish compensation. Possibility, but again, it would be very fact-specific, and they're going to have to have, obviously, scientific evidence to establish the causation element.

So one of the other questions that we got is if a person, if a first responder, let's say a city, has given their first responder Let's say they've allowed the person to travel outside of the area. Let's say they've allowed the person to travel outside of the area. Okay, what happens then if the person is traveling, but you know, because several healthcare facilities have allowed their employees to go to New York, for example, or another state to help out. What, what happens then?

If they're a—

if they're considered a frontline state employee, then most likely it would be found compensable. If they're not necessarily a state employee, then it would also be potentially be found compensable because under Florida law there is a theory specifically dealing with traveling employees, and that's specifically found under Section 440.092, subsection 4. So traveling employees are those defined as an employee who is required to travel in connection with his or her employment who suffers an injury while in travel status, and they shall be eligible for benefits if the injury arose out of an course of their employment, which they are actively engaged in the duties of employment. There is an exception, and that is if the injury results from, from or during a distinct departure on a nonessential personal mission. So that would also, again, would require some, some investigation to see if, if the alleged exposure happened while they were actually performing their job duties. As opposed to going out to dinner, which at this point I don't believe there's any restaurants that are open, but doing some other type of personal activity.

So one of the— one of our attendees asked a question, and I'll sort of have— I'll answer part of it and then I'll give the other half of it to you. The question was, are the theories that you've discussed federal, state, or local, or how are they? So part of what we're trying to do today is give you broad view. Some of it is related specifically to the state of Florida. However, OSHA is all states. The directive around COVID is being issued by Department of Labor. It's being issued by OSHA. That is all states. What I would recommend that everyone on our call today do, there there are going to be unique situations within your state. Compensability is what we are all going after. You know, we're looking at not did the person get exposed, how did they get exposed. That's a part of your investigation. The question is, is it compensable? And that question is universal in all 50 states. It doesn't change whether you're in Florida or Iowa or Texas or anywhere else. Compensability is, is the primary issue. So I'm gonna go through a couple questions that your insurance carrier should be asking you about investigation when I get to my turn, but I wanted to say that. But Omar, I wanted to, you know, throw that back to you as well.

No, yes, the 3 specific legal standards that potentially could be used to secure compensability of an exposure COVID-19 are specifically the ones that are available under Florida law. Universally speaking, from the research I am— have conducted, the consensus is, is that the virus is not necessarily an injury, but it instead will be analyzed under the state law to determine if it is an occupational disease. And generally speaking, to be an occupational disease, Again, subject to state law variations, an employee must generally show two things. The illness or disease must be occupational, meaning that it arose out of and in the course of employment. And two, the illness or disease must arise out of or be caused by conditions peculiar to the work and creates a risk of contracting the disease in a greater degree and in a different manner than in the public generally.

And that is the, the general consensus.

Um, again, not Florida, because I've outlined already the Florida standard, but according to my research, generally speaking, that's how they would attempt to secure compensability.

Okay, so from a standpoint of the employee was already out on workers' comp, so we'll go there again. Employee's already out on workers' comp, They're now laid off because the company's closed, and we are looking at owing them TPD, or the employee was out on TT, temporary total, and that's, you know, the same everywhere. So they're out on temporary total because they were pending a surgery, and now there is no surgery. What's your recommendation?

Well, first off, um, although I am a defense attorney and I'm always trying to save my clients money and minimize their exposure, um, I don't believe you can necessarily penalize an injured worker who's on a temporary total disability status and is now unable to secure the surgery through no fault of their own. So I believe in, in that situation, Um, the carrier would have no choice but to continue temporary total disability benefits. Um, with regard to temporary partial disability benefits, that is where I'm seeing a lot of questions from my clients. Um, that is where there is somewhat of a gray area because there's not necessarily a yes or no answer. And it is a question that I believe will truly have to be determined on a case-by-case basis, because it's honestly, it's hard to predict how a judge would ultimately rule in these types of cases. I know that some clients of mine do not want to establish a bad precedent. They do not want to look poorly. In the eyes of the judges of compensation claims. Um, so they're concerned about public perception and even public policy. Um, but what I tell all my clients is that we have to be focused on, on what the law says with regard to temporary partial disability benefits. And in Florida, under Section 440.15, subsection 4A, Temporary partial disability benefits are payable only if the claimant has not reached MMI and the medical conditions stemming from the workplace accident, and not the claimant's own subsequent behavior, choices, or decisions, create restrictions on their ability to receive wages or return to work. And there are two elements that have to be satisfied and proven by the claimant to receive TPD, and that's number one, present medical evidence of work restrictions that are specifically attributable to the compensable injury, and two, the claimant must also show that the loss of earnings is the direct result of the compensable work restrictions without intervening causes. Arguably, and where all my clients are struggling with, is the intervening cause. I have large employers that own several hotels here in South Florida that are completely shut down. No one is working. And their response to me is, there is an intervening cause. We have a government shutdown. The fact that this injured worker is no longer being accommodated within their light duty work restrictions is because we are shut down. That has nothing to do with this work accident. And to a point, they are correct. And so in those situations, the law states that the injured worker would have to go back and attempt to establish those two elements I've already outlined. And some of the case law indicates that one of the ways they could potentially establish entitlement to temporary partial would be through a, a good faith work search. And also, you know, any attempts that they can make to try to secure employment. Again, one of my clients pointed out to me, for the most part, everything is shut down. Where are these injured employees going to obtain work? And they have a point. So it's, it's, it's a very tough decision.

And I think that I, what I am recommending to clients is that they do not necessarily apply either we pay everyone or we don't pay no one.

I think you need to look at each case, um, on its own merits and determine whether or not you really do have exposure for temporary partial analyzing those two elements. Um, and one of the things that I'm also mentioning and to my clients is that as part of the stimulus package, the federal government will be raising the, the amount of unemployment benefits. Here in the state of Florida, the current maximum amount an individual could receive is $275. It is my understanding that as part of the stimulus, that amount will be increased by an additional $600. And that's going to be available for up to 4 months. And in total, they're going to be receiving up to 39 weeks of unemployment benefits. So if you've got an injured employee who is now receiving $875 a week, I strongly suspect that is going to be a lot more than their TPD compensation rate. And in the state of Florida, we are entitled to a dollar-for-dollar offset. So we may not even owe them anything. So if there is a silver lining, that would be it.

So that's something I want to reiterate again. I think that that applies everywhere. It applies in all the states. It may even apply in US LNG and the other longshore claims as well, where you're able to take an offset. We do consulting work in 16 states, and in the states that we do work in, which is all the ones in the Midwest— Texas, Oklahoma, Louisiana, those others— if a person collects unemployment, they are— the workers' comp benefit is offset. So I think sometimes we get in the hairs of the fight about the situation, and we're fighting about the situation, and we're missing the point of, oh, wait a minute, there's a bigger issue here. We do get to take an offset. We do still have to send out, um, the DWC forms to the injured worker as if we were still practicing the normal process of workers' comp. Workers' comp did not shift because of COVID-19. In fact, what instead happened is we need to just look at our processes and our procedures. Um, some, um, Cynthia, one of our our attendees just asked is, can we compel the injured employee to apply for unemployment? Here's the deal, nobody's going to sit down at home right now with no job and no possibility and not apply for, for unemployment. It is a strong suggestion. So from an HR standpoint, I don't think that there's anything wrong with you reaching out to the injured worker and saying, you know, we found out you're also eligible for unemployment, go knock yourself out and apply. I think sometimes we need to Not assume that the person doesn't want to do something. They may just not be informed on how to do it. So Omar, I'm going to take a pause from you. I'm going to continue to look through the feed in terms of questions, and I'm going to go to Catherine. And Catherine, you're up next. I'm going to unmute you, and I'm going to go ahead and mute you, Omar, while we're going through the next step. And so Catherine, Tell us about what's going on in the state of Texas, and also tell us how, given the questions you've heard so far, how you would manage some of these challenges.

Well, much of what Omar has said is very similar to what Texas has also adopted or working on pending processes to help all of, all of the parties involved with an injured employee. In the workers' comp space, or in Texas, as you know, we have non-subscribers as well, and those are also treated, or the needs are the same. The injured employee is there, what do we do? And so, you know, we all represent different parties today, and we all bring different perspectives of how we're managing them. What are the challenges? As a managed care company, and we have case managers, precertification nurses, pre-op nurses, bill reviewers, We have an organically grown healthcare network educating those providers. But mainly, if you think about it, the best way to really work these cases is to manage the providers. Well, many of these providers, as we know, were not ready for this. None of us were ready for this. But I think in looking at the tools, many providers are stepping up to the plate and saying, we want to do telemedicine. One of the challenges that I believe is going to occur is the fact that just because a provider says he can do telemedicine, what kind of telemedicine can he do? How easy access is it to perform telemedicine with our case managers and maybe even within the network? And are they following good processes and are we able to track and measure? But even so, the fundamental thing is whether or not these telemedicine doctors are credentialed and contracted to protect all parties, whether that be the carrier, the adjuster, the securities of the back and forth with the actual injured employee, or even working with case managers and how quickly we do get information through telemedicine. So I would say in our 8,000 providers in the state of Texas that have a contracts with us, we had to go out and make sure that they did have appropriate and good software systems platforms to help the efficiencies of the communication between all the parties and had to develop a complete separate contract that would allow a good measure of quality control so that there was accountability put in place. The last thing our industry wants is a bunch of new services like telemedicine without being able to manage and measure really the process of telemedicine and the outcomes. We do know by history, obviously, that case management— if you look at the challenges of a case manager, Margaret Spence, you know, they're out there in the field usually, or they're telephonic or field. Well, they're not going out to the field now. They have figured out ways that they have to be remote. They have to work on the cases, even if it's an audio process of telephonic. It's not with visits. But the other pushback to that is obviously the visits are limited now, and the telemedicine at this point doesn't really go through the full process, meaning that a treating doctor may see the actual telemed— a telemed doctor— but then what happens when rehab is required, physical therapy? So I think in a matter of By the end of the business day today, Texas Department of Insurance, Division of Workers' Comp in Texas, is going to be adopting and allowing telemedicine to occur within physical therapy and occupational therapy, or rehab, per se. Now again, the challenge is going to be how many of those providers can and are equipped, no different than the doctors, to perform telemedicine. So we're going to have a supply and demand issue that's going to hit all of us.. And our new norm, with time it's going to grow and I think it's going to become more sufficient. But I think we need to be careful that we are not jumping in and allowing just anyone doing the services without pre-qualifying them and measuring outcomes with them to facilitate the outcomes as we might see that this might be a new norm. This might be the transformation of our industry with workers' comp or occupational injuries. That we're dealing with for months to come, or maybe even make us think differently on how we're managing cases in the workers' comp space, right? Yeah. So I think overall we are equipped and ready, and those of us who are on the phone listening and a part of this panel, we're actually all quite very passionate about offering services that are necessary for us to move the cases along The education in the state, Margaret, one of the other things that's coming up and that's going to come up is in Texas, like in many other states, we were dealing with all kinds of other— I'm going to say challenges in relating to PTSD or cancer cases, presumption rules, and this is going to be now the COVID-19 challenge, right, that we're all talking about. And there'll be also things put in place that states will be adopting. I know we have completely— we're 100% remote at IMO. We're able to efficiently manage the early intervention of cases and move them along in all levels. But the challenges are no different. And the states are all looking and their eyes are wide open to facilitate. The rules are there. And that's what these providers are waiting for. How do I bill for this?

Yeah, that's the big question. How do I bill for it? So one of the questions that came from the panel was how do you do telephysical therapy?

Well, when you talk to the physical therapist, you know, many of them will, if they do it by electronic, a telehealth or a teletherapy, we're going to see a lot of different names come up here, telerehab, they're going to do an evaluation in the sense of more observation if they have the right software and application to actually facilitate facilitate more of an objective. It might be through— I'm going to just say as an occupational therapist personally, it definitely would need to be in a secure environment and facilitating that the patient, whether it be treating doctor, a specialist, we even have specialists who are signing up to do telemedicine. Obviously you're not going to do things that are not allowed in a telemedicine environment. But the The security of the environment needs to be the same. Monitoring and managing exercises, therapy, communicating with them on things to do with how to take care of the pain so that they're able to show the person their range of motion. They might be almost like functional activities through observation. You know, how much can they lift, push, pull, carry? And they might be asked to, in the home site, provide services or availability to tools that the therapist can evaluate and observe that so that they're able to come up with their documentation. We're going to all get really creative in the therapy side in terms of being able to do telemed or tele-rehab going forward.

So we had a, we had a question. Actually, the question popped back to Omar. I'm going to say it and then Omar, you can think it through well and then we'll come back to you on it. What happens if the employee doesn't test positive, but they've been sent home for the 14 days? And it's been— they, you know, their exposure occurred at work and they're sent home for the 14 days. How is that handled under comp? So that was one of the other— one of the questions for Omar. The other one was if you're a self-insured employer, Do I have to comply with what the state of Florida, our CFO, said about offering workers' comp to our high exposure people? So that's something else there. Somebody wants to know about that. So Katherine, from your standpoint, the question that often comes up is How do we, how do we ensure that the employee who is in a telemed connection with the physician, that they're able to get medication? We had a pre-conference question from one of our attendees where he wanted to know, can telemed doctors prescribe opioids? Can they prescribe medication based on where we were before? Can they renew prescriptions the way things were before? What is, what is your take on that?

Well, the providers that do telemedicine obviously have to have the ability and the knowledge and the license to prescribe medication, and they will do it no different than they do today. You know, when you go to your family practitioner today, whether it be on the telehealth on site or not, they have access to your pharmacy information. They're electronically submitting the request for medication. So I'm going to say yes, they will have the access. They're doing it already. Many of our providers out there that have good electronic medical systems where they're all tied in with the pharmacist and they're doing that. In addition to, I would anticipate more mail delivery, obviously, of pharmaceuticals to the homes, no different than some of the group health that are trying to promote that now instead of going to the pharmacy. That's probably going to be a bigger identification. The pharmacy benefit management groups that are tied in with the companies, the TPAs, the carriers, the managed care companies, the, the PBM is, is really critical in how great of an efficiency tool, resource, process that they can provide too. And I would think that that's a great party to have around your table as you work through those kinds of challenges.

What is the—

what's the advantage of telehealth, especially, for example, one of our panelists says, you know, if you— apparently in Georgia, the requirement is that you must be seen in person to have an opioid prescribed.

OK?

So if you run upon something like that— and I know, yes, Dan is who asked the question. And I know that for a fact there are several states that have that in the law that says I must see the white of your eyeballs to give you an opioid. So what are you experiencing when it comes to that?

You know, because Texas has taken such an aggressive role in decreasing the opioid challenges that we were having years ago, these injuries that are happening, the discussion of opioid is not necessarily on the top line of the platform for us to be dealing with at this point. If it is, I'm sure it's going to be an ongoing assessment as to maybe cases, depending on how long we're out. Again, in our, you know, stay-at-home orders that everybody's going to have, people will get perhaps more depressed, they'll have more anxiety, there'll be more mental health issues perhaps that we're going to be dealing with, and so that will be definitely a challenge.

Yeah. What's your recommendation for continuity of care? Given where we are now? How do we track continuity of care? And I think that's the big question. Even Dr. Nelson touched on it a bit in terms of continuity of care. Now, we have continuity within the primary care, but I'm sure that there are issues within the specialty areas. They're not able to do surgeries. Their offices may not be open. We had up in Tampa one of our occupational— one of our orthopedic surgeons in Tampa actually tested positive for COVID-19. So their office completely shut down for about a week, a little bit more than a week. They shut their office down. So in terms of continuity of care, what is your recommendation from a case management standpoint?

Well, we instituted— the actual telemedicine was adopted in 2018. And last year, we launched our telemedicine model and really got all of our telephonic field case managers involved with telemedicine as an early intervention. So we do what we call an E-InteleMed, an early intervention telephonic case management triage, if you want to call it that, where we're still ensuring that the telemedicine doctor looks at evidence-based practices, identifying based on the diagnosis that they're going to give them, um, that there are progressive or prognosis of return to work or treatment for that matter and their treatment pathways, what's expected. And so we get on the cases so early on. Like in many states, you have different environments, tech companies that are in networks, healthcare networks, those that are not. It really doesn't matter in this scenario because everyone can exercise. Telemedicine. It doesn't require or have the implication of location because you can have a Texas doctor that's in one side of the county that can go treat and see someone on telemedicine on another, which, which makes it so positive and great to get early intervention and continuity of care moving. So, so much of the documentation, the feedback, even file reviews can be done through, you know, interface of conferences and ensuring that the cases are moving along, identifying the outlier type of cases that will have to be looked at very closely and managed so that they don't get lost in the cracks, if you will, through this phase that we are going through. So communication is so critical, as we all know, and I think we're going to have to come up with some more proactive early intervention case models so that we're measuring the outcomes of these cases. Our telemedicine doctors will give a work status, or we call in Texas DWIC 73s, update reports or work status reports for our non-subscribers within 30 minutes to an hour at the latest, their work status. So in some ways, we're going to see some real positive communication efforts for continuity of care with our telemedicine model. The IMO Connect model. Hopefully this is what other people are putting in place. You know, what are the measurable outcomes? How happy are people? In the last 3 weeks since we've been remote and have seen now many cases going through telemedicine, I will say that the satisfaction of the care has been pretty high in terms of the, the efficiencies getting on with the software, the link. We use a preferred telemed advisor, ReadyMD, here in Texas, and they have a wonderful, efficient software. Very easy. No, not cumbersome at all in terms of assessing the cases and getting on with them. All of that plugs into great continuity of care, Margaret. So these are some things to measure as you sign up providers, you work with them. How quickly, how effective, you know, how's everybody really working together to get the cases resolved and back to work?

So if I'm an employer, and this would be my last question for you right this second, if I'm an employer, what are you telling me that's good? Well, what do I have to do to make this work? What's the one thing you want to tell me to make this work, the telemedicine?

Well, I want to provide tools for you as an employer employer, whether it be a video, whether it be information of contact, an 800 number, a 24/7 call-in service. I want to be able to have the employer have easy access that's smooth and simple for anyone sitting in whatever location they might be to move their case along, to let them know that they're being taken care of, you know, that we're taking care of their people, and that the communication is there, and try to soft touch all of the fear and the anxiety. They're going to be taken care of. But I would say easy access and tools, 800 numbers, 24/7 availability, having the right doctors who really believe in customer service, whether it be telemedicine, not a face-to-face visit. You know, they say that what, 85%, at least on an average of cases that have workers' comp injuries or occupational health injuries will get resolved in a telemedicine model. They will not have to go into the clinic, and I think again this is a transformation of the new normal for workers' comp.

So we have a question from Karen— asked this question, and I may be saying your name wrong— but is, is the claimant attorney allowed on the telemed— telehealth call. So if you get someone who has a litigated file, is it— is the attorney allowed on that telemed call?

I would think that that's a provider preference if they want that party to be involved. I would probably venture to say that the provider would say no because of the confidentiality, the HIPAA, the, um, you know, patient-doctor relationship, etc. So even today without COVID-19 in the picture, always we would need to get approval, you know, for the right parties to say that that would be okay. So good question.

Okay.

Another one was, um, how do you handle the workers' comp nurse case manager within the telehealth process?

Well, the case manager will have the the connectivity with the actual physician also discussing the case through telemedicine. It will be the physician and the case manager. I'm always looking at new ways to help facilitate the case management. But keep in mind, telemedicine is audio and visual, and many telephonic case managers today use audio. There are probably providers that don't have the software and they're going to use audio. But they're not going to probably get— that's probably more of a screening process or phone interview conference versus a telemed looking at them. If you go to the IMO website today, injurymanagement.com, you will see a video there and it will talk through and show you the process of that telemedicine activity that would occur from all parties.

They want— we've got another question for you as well. This other question was, what percentage of cases can be resolved via telemedicine that you're thinking or you're seeing?

Well, statistically, our telemedicine providers will say a good 80 to 90% can be resolved in telemedicine.

Wow, that's a big number. Yeah. Do you— are you tracking— because one of the things that I want to let everybody know that's participating in our webinar. Catherine's network is also rated by the state of Texas, and so the state of Texas puts out these satisfaction surveys every year. And one of the reasons why I invited Catherine along to our event is because her network has consistently ranked one of the highest in Texas, and, and the care and services that are been provided ranks at the very top. So my question to you is— and we will probably cover this on our next webinar. As I've said to everyone, we're going to actually do a pretty in-depth one on telehealth. So if you have questions about telehealth, please put that into the survey so that we can sort of prepare to answer them in the webinar that we're going to do in about 2 weeks. We're going to probably bring back Dr. Nelson. We'll bring back Maxine. Max, who's on with us, as well as Katherine and Katherine's team, to really talk about telehealth and how it impacts. So the question is— and this would actually be for you, Max, and I'll unmute you for a second to answer this. Someone's asking, which is a Florida person, will the telehealth MD be expected to provide a DWC-25 following the visit?

And the answer is yes. The telehealth experience will include DWC-25s. And it's interesting because in Miami, not only are we dealing with that, but we're dealing with trilingual telehealth because we have English, Spanish, and Creole telehealth. So it's even more involved down here in Miami.

Right. And Katherine, are your telemed physicians providing all the state forms that are required in the state of Texas, and is that a standard expectation across the board with telehealth? I think it is, but you can answer that.

Yes, I would say that it is, and keep in mind, even though our, some of our doctors, or a lot of them, are here in Texas, they are doing telemedicine in all states, at least 40 of the states, so, you know, it doesn't matter where they're actually doing it from. It's just the access of the provider, you know, to do telemedicine.

Okay.

All right, great. Omar, I'm going to unmute you so that you can answer your question that was posed earlier to you. Sure.

From what I wrote down, I believe one of the questions was if an individual who alleges to have been exposed to COVID-19 at work, is quarantined for 14 days but never tests positive. That would not be a compensable claim because in order for you to have a compensable claim, you would have to test positive for the virus.

It's almost—

the analogy is you can't be a little bit pregnant. You're either pregnant or not pregnant. So you either test positive— I'm sorry—

or you don't.

You either test positive for COVID-19 or you don't. So if they do not test positive, there is no claim or there's no benefits that they can receive.

OK. So one of the things that we were trying to do on this webinar is to have some carrier, some insurance carrier perspective. But one of our panelists couldn't make it. So one of the things that I want to just sort of read off to everyone about what she said. So the question that I'm going to answer is this. What should you expect from your insurance carrier if a COVID-19 case is presented or reported in— into a notice of injury? And so that's a question that nobody asked, and I think it's imperative that we answer that question. One of the things that we must expect as employers, HR professionals, as workers' comp professionals, is that an investigation into COVID-19 is no different than an investigation into any other exposure claim that shows up and you're on your desk as an adjuster, or that you file as an employer to the insurance carrier. And I see Omar, you're nodding your head. It's no different. Every case has to have a thorough investigation. Investigation. That investigation process doesn't change. You know, in workers' comp, and this is something that I want to stress to everybody, in workers' comp, it's not the coverage. Every employer that is participating in the workers' comp system has purchased coverage. We're not dealing with liability and auto and so on where we could say, well, you know, he didn't buy enough coverage. Coverage is not the issue. The issue is compensability arising out of the employment and exposure directly related. One of the questions that someone just posed, which is a Texas question, Catherine, is for non-subscribers, are all COVID-19 claims considered compensable, or they determine on a case-by-case basis? I think it's, it's case-by-case.

Well, actually, it's, it's actually based on the non-subscribers' ERISA, or what we call work plans, and those plans are probably being reviewed across the state of Texas with our non-subscribers in terms of what should be covered and what's not. That's their— for the non-subscribers' frame of reference is really their work plans or ERISA plans that would identify what's accepted.

Okay. So I hope— Scott was the one that asked that question. And as you— as Katherine answered, it's based on your non-subscriber agreements, basically. It's pretty much within that framework. There was a question from David that's posed. Might there be future disputes or distinctions between a positive test versus a positive medical diagnosis? Omar, what do you think about that?

Hmm. Interestingly enough, the directive indicates that for these frontline state employees to be covered, they have to have tested positive through a reliable method. Reliable method has— is not defined in the directive. So I believe that it would have to be an acceptable scientific study or test which it would be accepted in the community for it to be a positive COVID-19 diagnosis. I don't believe— my understanding, and again this changes day to day, is that a physician cannot just simply examine you and diagnose diagnose you with the virus, that they have to take a sample or swab of the inner mucosa of your nasal cavity and be sent out to a lab or, you know, so it's diluted in some substance to see if the virus is present. So I would think that it would have to be an actual lab result as opposed to a doctor's examination determination or conclusion based on symptoms.

Right, right.

And I agree. I think that's what the CDC has been saying. I've been listening to Dr. Fauci over and over and over again. I think I have Dr. Fauci memorized in my brain. Like, I go running to listen to Dr. Fauci and all the other experts. But I think that is a general assumption. Now, I have another question, and it's a two-part question.. And I'll answer part of it, and Omar, I'll throw the other part to you. Cynthia asked the question, do you expect for employers to report all claims that there's a potential exposure to an infected person? And should employers only have to report someone who was exposed to a confirmed positive and is having symptoms, or the employee who is being tested, as being investigated, or positive. And the person surmised that a lot of people will file claims. So one of the things— and I'll back up a little bit, I'm gonna answer the question as an adjuster first and then as a risk management consultant second, and then I'll leave the rest to Omar to answer from a lawyer standpoint. Okay, so here's the first one from an adjuster standpoint, because for those of you who don't know me, years and eons ago, I was a work comp adjuster, and now I do work comp consulting. So, and I somehow didn't introduce myself at the beginning. I introduced everybody else. So, you know, Margaret Spence. It's all good. You guys will figure out who I am eventually. It's irrelevant at this point. So one of the things that, that has always been customary. So imagine this, a nurse is in a hospital and they get a needle stick. There's an exposed patient who has maybe HIV or hepatitis or whatever. That person gets reported into your carrier as a medical only, not seeking treatment. It's there. They're under surveillance for 6 months generally for HIV exposure or hepatitis exposure or other types of exposure. So there's your example. In a similar manner, medical exposure type of situation. There's already OSHA logs for exposures. The OSHA log has existed before COVID-19 for needle sticks and exposure issues. There is a separate OSHA log for exposures, so I want to point that out, and maybe we will do a program on the OSHA log and the exposure around COVID-19. COVID-19, because I think people need to understand that there is a confidentiality still within the OSHA process around adding a person to the OSHA log who is a suspected exposure and a potential exposure, and you're dropping their name onto a regular OSHA log. So in my opinion, I would report it in, because one of the things that you don't want to have happen is somebody come back next year and say, oh, by the way, you know, I had that COVID-19 exposure and I'm lawyered up now. Omar, you take this one.

Sure.

Before, I do want to say that OSHA has provided guidance and they do require the recording of instances of workers contracting COVID-19 if the worker contracts the virus while on the job. The illness is not recordable if worker was exposed to the virus while off the clock. So that's the distinction. But as you were pointing out, OSHA does require that it be reported as long as the exposure is work-related. With regard to, to what you were saying, I do agree that if there is an individual who believes they've contracted COVID-19 and they do have a positive result, then obviously yes, you should— an employer should immediately report it to their workers' compensation insurance carrier. In the state of Florida, the, the adjuster, the carrier, has 14 days to make the decision to pay or deny the claim. That's 2 weeks, that's 10 workdays, which is a very, very small amount of time to be able to gather the medical records, speak to, to the the different coworkers. So there is a time crunch. So the sooner you report it, if it's a positive COVID-19 result, and they're alleging it's work-related, you should immediately report it. The other avenue that the carrier could take in that situation is to avail themselves of the 120-day pay and investigate. But in that situation, the carrier employer, as it says, has to pay. So they will be providing for the medical care and any associated lost wages, any, any temporary indemnity benefits that may be due. So yes, report it. Now, if there's a question that someone believes or suspects, that's a hard one. That's a hard call because I mean, I guess you would, you should be calling it in and advising them. However, at that point, I'm not sure what investigation the carrier would do without an actual positive result. I'm not sure what, what obligation the carrier would have to really investigate to determine if it's—

if this is something causally related, because we don't even have a positive result just yet.

I think certainly they could to put them on notice if they believe that there's several individuals who've been exposed to someone, just to kind of give them the heads up. And I guess, you know, the more I think about it, it would give them an opportunity to truly investigate and get a head start, you know, if it turns out that these individuals test positive. But that one's an interesting question.

Yeah, it is. Our person that asked the question sort of elaborated a little bit more. She said her example is— and thank you, Cynthia, for posting the question. The example is describing a first responder transports a sick patient, and the patient tests positive for COVID-19. The first responder is not sick and has no symptoms, but is not going for testing but staying home for 14 days. Does the employer need to report every time? Claim where someone has had an exposure to someone who tested positive. I don't think so.

I don't think so because, I mean, potentially everybody could be exposed to someone who has the virus and was asymptomatic at the time, and nobody knew that they were around them or that they were sick. So I would agree with you. I don't think you would have to report that.

Now, the follow-up question was, would he be unpaid for 14 days? So here's the deal. The Florida rules, the Georgia rules, the Texas rules, the waiting period still applies everywhere on the planet unless you're in Illinois, Oklahoma, and Iowa. You have a 3-day waiting in Colorado, 3-day waiting in Iowa. You have a 3-day waiting in— Colorado, Illinois, Iowa, and, and so on. So if you've got a 3-day waiting period or 5-day waiting period or 7-day waiting period, there is a waiting period. So that's half of the time the person's on isolation. The other 7, they're gonna have to be on qualifying for benefits anyway, so they're on 14. So by the time they get to 14, if they're tested negative or they're back and no symptoms, then they're back at work. There's no work comp exposure there. So we still have to use our clock we still have to go back to using our old traditional way of doing things. Don't let COVID-19 stop you from doing the right thing. Catherine, we have a question for you. It says, who has the burden of proof in Texas concerning exposure? Is it the employee or the employer?

Well, the employer actually, through the assessment or investigation of the claims, the third-party administration, when they do that part of it. But most— we do a lot of different municipalities, and I would expect that no different— nothing would change. We would look at those exposures and identify if there was any compensability part to that, but manage them, close them out, you know.

So Natalie, I'm bringing you in because And for those of you who don't know Natalie, Natalie's with WorkFinders. And one of the conversations that we had— Natalie had with me a couple days ago— was the fact that they typically find off-site work that is for injured workers. And one of the things that Natalie is finding is that there are nonprofits who are still looking for people to come to work light duty. So Natalie, tell me a little bit about how that's working and what your thoughts are on the future after COVID-19.

Yeah, thanks, Margaret. Yeah, so to answer the question that was the most popular one that we were all getting answered with regards to return to work was that, is light duty still available in this COVID-19 climate? And the answer is right now at this hour that yes. It is still available. And much like my co-panelists today, we're handling each claim on a case-by-case basis. But what we are seeing that is in some of the areas of the country that haven't been as greatly impacted and perhaps haven't had the formal shelter-in-place orders put into effect are South Dakota, North Dakota, Nevada, Utah, Montana. There's some of those areas of the country where we are able to successfully place injured workers. And in some of the places where they do have some shelter-in-place orders, there are charities and nonprofits like blood banks, like shelters, food pantries. There are some of these social agencies throughout our country that are going to need a great deal of hands and are willing to work with folks that have sedentary work demands or have limited physical abilities because they do also really need the hands to try to help those social agencies continue as now we have communities that are in such great need. So that process we expect to evolve, and it's something that we're flowing with and growing with on a daily basis. We're tailoring all of these light-duty opportunities, one, ensuring that if there is a chance to keep an injured worker placed, that it's in an environment that is, of course, safe for them and that they want to stay there. If we found a nonprofit that is needing to close their doors, we're turning over upside down some of the things that we might not have looked at in the past. The 600+ people on this webinar is a depth of relationships that we all have together. We're going to have to look at some of the things that maybe we didn't before, like working with traditional employers. Our grocery chains and transportation companies and folks that are still out there working on the front lines now, We're going to see a changeover of staff where we're going to have to try to help to fulfill regular positions, perhaps with injured workers in light duty roles. We're looking at really turning on our heads some of the things that we would have never done before. Right now we're looking at some ways that— how can we engage light duty workers, maybe having to bring things into a home environment. Again, things that we never spoke about because our goals are remaining guided by our intention of getting every injured worker back to good health and meaningful work regardless of what the circumstances are. So remaining guided by that. But my real call for action, though, today is for folks to identify their teams, get your ACEs in your places, and really start designing return-to-work solutions that injured workers are going to need. Start designing these now, because I think we all feel that the world is stop— the turning is stopping a little bit, and it may stop even more in the near future. And when the world starts turning again, we have to be ready to hit the ground running with solutions for injured workers. We can't be running behind be 10, 20 million people, Americans who are all going to be looking to get back to work and then trying to push injured workers into that mix. Then we have to be getting aggressive and intensive now to design those programs and carve those things out. So when we get to that, when we get to that point that we're ready to support injured workers so they don't get lost in the, lost in the shuffle. Pushed out the other side.

Yeah.

So Natalie, I totally agree with that. It's about what we plan now. One of the things that I want to talk about before we close— I know we're running a little bit over. We had some technical difficulties at the top. So I hope that those of you could stay a couple more minutes with us. From an HR perspective, it's imperative that as employers, we create some prudent policies. People are stressed right now. We've sent them home to stress. There are cases where people have died at home, working at home, because we've overworked them at home. So don't think that the workers' comp exposure for your at-work-at-home employees is diminished. We still have exposure. We still have things that can happen in someone's home that ends up becoming compensable, and Omar could probably speak to that. Yes, they can fall over the dog and try to file a claim. I mean, if they're talking on the phone to you and the dog runs by and they fall over, there are cases out there. One of the things that I did, and we weren't able to do it with the webinar, I did prepare a PowerPoint, and I had pulled up a couple cases. There's a case in Maine. There's a case in Pennsylvania where an employee was working at home, had been overtly stressed by their management team, had worked 10, 20 hours of work, and subsequently had a heart attack and died. One had a DVT from sitting at the desk for 18 hours. The other one had a heart attack. And both were deemed compensable. So I don't— I don't want us to think that we've sent the employee home, so now we don't have an HR responsibility for these employees who are working at home. And if we send them there, we've created an additional burden now where they're double taxed and double stressed. And then we have this issue happen. It's even more important for our first responders. The heart lung presumption in Florida still applies. I mean, our workers are under stress, our healthcare workers are under stress, so I don't want anybody on this call today to think that our workers' comp exposure is not where it was pre, uh, you know, post-COVID-19 because, hey, nobody's working, everybody's sitting at home. Our, um, our vigilance needs to be increased because we do have employees at home home, and we do have folks that are at home right now. So that's something that I want to at least say to everybody. Omar, is there any last thing that you want to add to what I said?

No, you make a very good point. And it's funny because in Florida we had a case of a workers' compensation adjuster who was working from home, who went to go put a— grab a cup of coffee and fell because her dog got in away and she sought to receive workers' compensation benefits. Ultimately, although the lower court found it compensable, the higher court said no because she could have been doing that regardless of whether or not she was working.

But they did set forth the law and basically said that you could have—

you could be working remotely from home and have an accident and it could be possibly compensable. And The case that I'm referring to is Sedgwick CMS versus Valcourt Williams, and it is found at 271 Southern 3rd, 1133. And that sets forth the, the, the elements for establishing in Florida basically a remote workplace accident.

Okay, so we have another question. The injured worker is sent home but has no positive results. The claim is not accepted. So would you cover the lost wages between the waiting period and the 14 days, or do you not pay for anything?

If, if it's a negative result, then I believe there is no compensable claim because the—

what you're—

the claim that you're accepting is the exposure and having COVID-19 COVID-19. If you don't have COVID-19, then I don't believe you have a compensable case unless you— I mean, unless you decided to accept the case under 120 days, you would have to pay and investigate. So that's, that's an interesting question. I don't, I don't, I don't believe you would necessarily have to pay.

Right. And so Yeah, that's really— this is a lot of gray areas, and I think that we will continue to do this. I feel pretty strongly because literally we had 635 people register for this event. We had at our height about 450 people participating, and we have other people that were supposed to be watching on YouTube. So I think that the questions are gonna keep coming. Again, we're asking you to fill out our survey at the very end. Post any questions that you have there. I'm going to also send out a claims management bulletin that we received from Continental West around this. We'll put together a minor handout and get that out to you within the next week. So Cynthia followed up with another question, Omar. If the test results aren't in by the 14th day, Do we pick it up under the 120-day was the question.

Oh, that's a good question.

I mean, then arguably you could.

And then upon receipt of the results, if it's negative, deny the case right away. But then you would be responsible for possibly if there's any lost wages, if it exceeded the 21-day waiting period.

But that would be—

That would be a good way around that investigation time period.

Right. You know, employers are going to be responsible, whether it's sick pay, whether it's leave pay, or however else you're going to go ahead and bank and make that employee whole. At the end of the day, this is when we sort of put some of our HR policies in the back burner. We're not setting precedence, and I think that's my view from the HR desk, is the fact that we are paying someone because they're sitting at home for 14 days, we're really not setting precedence if it's coming out of sick bank. We're having to do this because of this crisis. That won't be the normal the day after the COVID-19 lifts, so we're going to go back to our standard policies. And so, as Katherine said, it's essential that we communicate with our employees, not necessarily if they're injured or not, but we actually communicate what our policies are. And we also maintain some flexibility to be able to say we are flexible with that policy. This policy is going to be fluid. As Omar pointed out, you know, we may wake up tomorrow morning and we get a different kind of order coming out of the federal government or out of our state houses. So we're going to have to stay vigilant in looking at what is being decided for us at this point. You know, we're all being held in a cocoon and captive. Things are being decided for us. But I would stress to everybody on this call today that we're going to have to be flexible with how we manage this going forward. Wouldn't you all agree with me on that? Absolutely. Yeah, yeah. And I also think to what Natalie said is that we're going to have to begin our post-COVID planning now. You know, our employees that are going to be the onslaught of, oh my God, they need to have surgeries, they're going to be hitting the bricks to have those surgeries. They're going to be— you know, if litigation got put on hold because you absolutely need— I was speaking to one, an attorney last week who happens to be a friend of mine, and she said, well, I want to do this mediation in person. Because he's dodged and dodged us for the last 2 years. Yeah, okay, great, you want to do it in person, you're going to wait a year. In a year you need to be ready to go. So I think that's one of the things that, you know, like someone said, Karen said they like the idea of post-COVID-19. I'm thinking past this now. It's time for us to think, you know, yes, we're in the mire of this and yes, we're all caught up into it, but The question that I want to leave with everybody as our final thoughts and as we close is a statement that I made to myself earlier today, which is we never knew how resilient we were or we are until we have to be resilient. And so this is going to test everybody's resilience. So the question is, what do we— what will we change? What will we say What will we stop saying? And one of them that I'd like us to stop saying is, "This is how we do it." There is no "this is how we do it" anymore. Nobody cares about how you did it because of COVID-19. So we should instead question what we've taken for granted as "this is how it's done." That is really now upended. And I want us to think about how we value our employees. Employees, and that's something that Natalie touched on. How do we value our employees and how do we improve workers' comp, the entire system, so we can be better at this, better at what we do? And I want to leave this with Max. Is there anything you want to say from a physician's health center standpoint that you are doing locally in Miami for those of you who are in—

You know, we are doing everything and anything. I get requests for temperature checks at construction sites, that please provide somebody to be there when the employees arrive to take their temperatures. I'm getting requests for things that are not necessarily within the norm. A large company doing pre-employment's asking if we can now, in our pre-employment, add a COVID test, which of course we can't. These people are not symptomatic. It's just that they want to make sure they're not hiring somebody right now who's coming with COVID-19. We're having a person, a company that says their employees, as Dr. Nelson referred, are coughing, and I don't want them on site. Well, the person says it's a postnasal drip. I've done this my whole life. So we're dealing with daily these kind of questions. Respirator fit testing. I don't have enough respirators, but I'm a big healthcare system and I need to to fit the people for respirators. So there's just every day new questions, new situations, like the employer who needs telehealth in Creole. Got that set up today. So every day something new arises. You know, we're just handling it because you just have to move forward and we have to get past this crisis and all be healthy and stay healthy.

Right. Yeah, absolutely. Absolutely. So we're going to go ahead and end our webinar. I want to thank our key partners in this, which is Physician Health Center, Max and Dr. Nelson, Omar Perez and Miller Kagan, who gave us his time to be here today, IMO, Injury Management Organization, injurymanagement.com, Katherine's group out of Texas. And WorkFinders, Natalie's group. Natalie's in Wisconsin, I think. So we really went across board to do this, and just for everyone, so everyone knows, it's physicianshealthcenter.com, it's workfindersusa.com, it's mkrs.com, and it's injurymanagement.com. And for me, it's margaretspence.com, and we will be doing additional webinars, and we thank you very much for participating with us. And to our panelists, I so appreciate you. We pulled this together in a week, and we were able to do it and pull it off, and snafu and no snafu, we got it done. So thank you again. Everyone will get a copy of the recording, and we will make ourselves available for questions if you have them. Thank you, and everybody stay safe out there. Take care.

Thank you.

Bye-bye. Bye-bye.

Bye-bye.

Bye.