Along with the obvious public health concerns, the COVID-19 pandemic raises several questions about insurance. Will my health insurer cover testing? Can my business make a claim for lost income?
Although the answers from carriers, regulators and courts might change as the situation evolves, here’s how some of the most common insurance products are expected to respond to coronavirus-related losses.
Federal and state governments will pay for lab tests associated with COVID-19. However, hospitals might charge their own fees for collecting specimens and can pass those expenses along to consumers. For health plans regulated by the Illinois Department of Insurance, emergency care from an out-of-network provider (including ambulatory services and hospital care) must be billed as if it were from an in-network provider. Similarly, patients at an in-network facility who are treated by an out-of-network provider can’t be charged higher copayments (assuming no qualified in-network provider is available at the facility). In an effort to promote social distancing, telehealth services from medical providers must be covered as if they were part of an in-office visit.
Purchasers of life insurance may have been asked to disclose recent travel to other countries. If a consumer misrepresented this information on an application and contracted a terminal case of COVID-19 while in a high-risk area, the insurer might be able to deny death benefits. Otherwise, life insurance policies generally don’t have exclusions that would pertain to the present crisis. Policies with a cash-value component might decrease in value due to the pandemic’s impact on the economy but are usually subject to a minimum guarantee.
Workers compensation insurance pays for medical care and a portion of lost wages when an employee becomes injured or ill as a result of his or her job duties. Although eligibility differs by state, compensation for illnesses generally only applies when job duties or work environments made employees significantly more susceptible to illness than the general population. Historically, for example, ill workers have received benefits after being exposed to hazardous chemicals but not when catching the flu from a co-worker. Whereas most workers are unlikely to qualify for workers compensation due to COVID-19, hospital workers (and perhaps grocery store employees) might qualify due to their elevated exposure. Time will tell.
Commercial General Liability Insurance
This insurance is intended to respond when a member of the public is harmed by a business’s work or by unsafe conditions at an insured location. Although some coverage might exist if a customer were to contract the virus from someone at a business, it’s possible that the insurance would only respond in cases of negligence (such as a business continuing to remain open to the public after being ordered to close). Although some policies might provide benefits regardless of fault, those amounts are generally limited to no more than a few thousand dollars.
Business Interruption Insurance
This insurance compensates businesses for lost income and extra expenses when they’re forced to shut down through no fault of their own (including by emergency order of the government). Unfortunately for policyholders, coverage is typically dependent on “direct physical loss” or damage to property, such as a fire at either the insured’s business or a neighboring building. Interruptions that result in lost income but aren’t caused by a “direct physical loss” or property damage are generally excluded. Although COVID-19-related lawsuits have already been filed against insurers based on this language, carriers might still be able to deny claims based on other parts of the policy. For example, since the early 2000s, most business interruption policies specifically exempt losses due to viruses and bacteria.
As in all cases regarding claims, policy language can differ from product to product and carrier to carrier. Insurance professionals should carefully read the applicable coverage forms before advising the public about a specific loss.
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