Antivirals covered by work comp

3rdcareerRN · Sep 11, 2009

I can't speak for my facility, but healthcare worker exposure to influenza is viewed by one expert as being compensable by worker compensation:

http://www.workerscompinsider.com/archives/001042.html

I do not understand how antivirals would be paid for by worker compensation. That compensation system is set up to administer benefits to injured employees and to eligible family members of employees killed on the job. Although it seems logical that prevention can reduce injury/death, and antivirals are a prevention, the system does not seem set up to compensate for prevention.

tymatt2 · Sep 11, 2009

Thank you so much for your reply. The Infection Control Nurse at my facility said that our employees who are exposed to Influenza and request antivirals should have the medication paid for- just as if our employee was exposed to Pertussis and given antibiotics. I appreciate the link and look forward to reading it. I am so not ready for the can of worms that Swine Flu is going to open up.

3rdcareerRN · Sep 12, 2009

OK, I misunderstood "antiviral" to mean vaccination, not post-exposure medication. That certainly makes a difference. However, I cannot see how the type of infection (swine flu, seasonal flu, etc.) affects the medication-payment decision.

A potential misunderstanding -- the payer (the worker-comp insurance carrier versus the employer versus the employee). For the carrier to pay, the employee must submit a valid claim of injury and show work-relatedness. For the employer to pay, a employee-supporting internal policy or management decision is required. If neither of those pay, then the employee must pay (invoking personal medical insurance if available).

The employee may have difficulty proving that a pandemic infection is work-related if the employee might have been exposed while in the community, or if PPE use was inconsistent. For example, see http://www.heart-intl.net/HEART/OccIssue/Work/Index%20m-z.htm or http://books.google.com/books?id=GITdICD3GdkC&pg=PA1841&lpg=PA1841&dq=infection+worker+compensation&source=bl&ots=MVu_QfNPcu&sig=ogZ6X1TMLmr7Zs6DEPjZXdxn_Jg&hl=en&ei=N_yqSuTYO4SItgecnq2hCA&sa=X&oi=book_result&ct=result&resnum=9#v=onepage&q=infection%20worker%20compensation&f=false.

(Disclaimer: I am not an attorney, don't play one on TV, and do not hold out myself as an expert in this area!)

I don't understand your other question about local health policy overriding OSHA. Do you have examples?

We healthcare people are certainly on for a long, hard ride -- years ago it was polio and measles, then later HIV and SARS, and now swine flu. Every one of those, and whatever is to come next, has been scary and confusion-filled at first. I think we continue to learn and improve how we handle mass illness.

smk4450 · Dec 25, 2009

Individual State pays for all H1N1 imunizations, plus the alcohol pads and syringes needed to administer these injections.

EwwThat'sNasty · Dec 30, 2009

A lot really depends upon your insurance company (workers' comp) and the details surrounding the case as well as the state you work in.

If you have children, see an occasional worker, and then are later diagnosed with H1N1 you will most likely be denied by WC. In the state of NH you probably would not prevail if you took it further. In MA or VT where the worker is almost always right, you probably would prevail. The problem is: how do you know that it was a work related incident that infected you? If it was, then all care including antivirals would be covered as well as mileage driving to get them.

If though, for instance, your documentation on employee "x" noted: EE x presented to Health Services with sore throat and accidentally sneezed on me before I could put on an N95," and then four days later you developed symptoms, well, that's a no-brainer. You would likely be covered.