Almost 20 years ago, US health authorities believed the measles to be eliminated in this country. Since then, there have been at least two outbreaks, presumably due to the higher percentage of unvaccinated people. It is now considered by the World Health Organization to be a leading global threat. Here we will discuss how this epidemic can play out in the workplace and the factors that affect whether the disease is covered as a workers’ compensation illness. We’ll also discuss the difference between diagnosed illness and exposure and the best practices for communicating with your employees during an outbreak.
Symptoms and Risk Factors
Signs of measles mimic cold and cough symptoms, such as high fever, runny nose, and red and watery eyes. A rash develops, usually on the face and neck, and spreads to the hands and feet.
The disease is highly contagious and is spread by breathing, coughing, sneezing, and personal contact, even before signs of rash appear. The virus continues to be active in the air and on infected surfaces for up to two hours.
But the measles doesn’t only cause unpleasant symptoms; it can also be deadly, according to the US Centers for Disease Control and Prevention, as complications can be severe, even fatal.
Those who have been vaccinated are highly unlikely to contract the disease, but there is still a small chance. The measles is part of a two-dose vaccine called MMR, which also guards against mumps and rubella. The CDC estimates that 93% of individuals who get the first dose have immunity. This rises to 97% for those who receive a second dose. Once a person has had the measles, they are considered immune for life.
However, unvaccinated people, especially pregnant women, young children, and infants who haven’t been vaccinated yet, are at highest risk. Anyone who hasn’t been vaccinated and who is in close contact with the affected person has a 90% chance of contracting the illness, according to the CDC. That’s why “herd immunity”––when a sufficiently high number of the population is immune––is so important; it protects those who cannot receive the vaccine.
Is the Measles Covered By Workers’ Compensation?
The answer to this depends on a lot of factors.
First, it’s important to understand that an occupational illness or injury is one that arises out of and in the course of employment. The “but for” test is one way to sort this out. This test connects the employment to the illness or injury and is stated that “but for” the employment, the illness or injury would not have occurred. If there are no special aspects of the employment, including the work conditions, environment, or job duties, to cause or contribute to the illness, then the illness was just as likely to have occurred in a different non-work setting. In this case, the illness is not likely to be covered under workers’ comp.
State jurisdiction is another consideration. In some states, there is a “common risk” rule which bars compensation if the conditions of employment pose no greater risk than what would be found in the general population. Other states use a 50% threshold, where the employment must be the predominant cause, at least 50%, of injury or illness.
For most states, the topic of coverage won’t be obvious and will depend on the case-specific facts. California Disneyland employees who contracted the disease during a 2015 outbreak were covered based on their large exposure to the general public, specifically unvaccinated foreign visitors. Conversely, an administrative support employee working in an office who noticed symptoms while at work and was later diagnosed with the measles after going to the doctor was denied workers’ comp benefits because there was no link to employment. On the other hand, this same employee put other employees in the office at risk by bringing the disease into the workplace. These other employees’ measles-related workers’ compensation claims were covered.
A person’s industry, occupation, and workplace are relevant factors in whether their workers’ comp claims would be covered. Firefighters, healthcare workers, police officers, school staff, daycare workers, and any employee having significant contact with the general public are more likely to have their measles claims covered.
The Difference Between Diagnosed Illness and Exposure
All employees are exposed to workplace hazards, injuries, and illnesses. However, this does not give rise to a claim without actual injury or illness. The measles is no exception. An employer’s obligation to report a claim is triggered when an employee reports a work-related injury or illness. If an employee believes they have been exposed to measles, and it has not yet been diagnosed, employers should encourage the employee to contact their primary care physician as opposed to being directed to the occupational medical clinic, such as an MPN.
Once the condition is medically diagnosed, the employer should quickly decide whether a workers’ compensation claim needs to be filed. Obviously, if the doctor indicates the illness is work-related, the employer should report the claim and refer the employee for workers’ comp treatment. If there is any question as to the causation and compensability of the disease, a claim should still be filed so the carrier can take proper steps to investigate.
In the event of exposure versus verified illness, what is the best course of action? If one employee contracts measles, should other employees be tested? This seems like a proactive approach, however, depending on the employee population, there could be a downside. This could be costly, productivity could be interrupted or trigger unwarranted claims. The risks should be weighed against the benefits. An insurance carrier is only responsible to pay for workers’ comp treatment and benefits for medically-confirmed cases of industrially-caused measles. Most carriers will not handle or cover the cost of preventative diagnostic testing. For those that might analyze the cost of having the carrier pay versus self-administering. Employers on a high deductible plan must still pay under their deductible limit and having the carrier administer the testing may be more expensive due to their high administrative costs versus the employer paying for testing. Whatever type of insurance program they have, employers should be aware that by asking their carrier to pay, their loss ratio and workers’ comp premium could increase.
Perhaps a better alternative, should you find that your workplace has been exposed to measles, is to do what schools and day care centers do. Provide notice to your employees (and post at the workplace) advising of the exposure and give employees suggested steps to stop measles from spreading in the workplace.
Best Practices for Managing and Communicating with your Employees During an Outbreak
First, monitor for signs of measles. Employees who display symptoms should be encouraged to see their physician immediately, and in cases of confirmed diagnosis, stay home until cleared. If there has been measles exposure, communicate with all staff, both verbally and written, to minimize the spread of the disease. It is important to withhold the names of affected individuals to protect privacy and confidentiality.
Second, educate employees on measles symptoms and immunization. Encourage vaccination. Employees who do not remember having the measles or a full two-dose vaccination should be encouraged to consult their physician. Also, due to different variations and effectiveness of the measles vaccine during certain historical periods, people born before 1957 or who had the vaccine in the 1960s should consider getting another one. There is no harm in getting re-vaccinated. Blood tests can even confirm immunity from previous vaccines if someone is unsure. If an individual is not immune, a booster or new two-dose vaccine, depending on a physician’s recommendation, can be administered.
Employees should be referred to their personal care physician for vaccination. Employers might also consider covering the cost and hiring a third party to administer measles vaccinations on site. To ensure compliance with ADA, anti-discriminatory, HIPAA, and other employment laws, employers should consult their labor attorney before asking employees whether they’ve ever had the measles, have been vaccinated, or if considering making measles vaccination mandatory. Some industries, such as healthcare, may be able to mandate vaccination. However, some individuals have complicating medical conditions or allergies which preclude vaccination. Also, some states protect people from opting out based on religious and personal beliefs. Unless the type of industry, occupation, or state law allows mandatory vaccination, the best practice is to provide education and information without demanding action.
Third, consider hiring a third-party service to clean the workspace of the affected individual. If possible, offer telecommuting as an option to exposed employees until the risk has been cleared.
Supervisors and leaders should be trained to respond appropriately.
County Health Departments and Civil Authority
County health departments monitor for communicable diseases and have the civil authority to control follow up action. Employers may find that they must cooperate with the health department in this effort. Once an individual is diagnosed with a communicable disease such as measles, the treating physician is required to report the case to the county health department. This does not occur 100% of the time so you may find that a call you as an employer make to the health department could be their first notice. The links below provide insight into the types of diseases which the treating physician must report.
If an employer becomes aware of a possible exposure event involving a reportable, communicable disease it is a prudent step to contact the county health department to help you decide what the next steps should be. If the treating physician did contact the health department, they may reach out to you. The links below provide contact information for counties in California, Colorado, and Oregon.
For more information about workers’ compensation claims and dealing with outbreak in your workplace, contact your Woodruff Sawyer Account Team.