Reporting a Workers' Compensation "Exposure" Claim 

By Sarita Shipe

Exposure claims are very complex and raise many questions for employers. When reporting a claim that you or your employee may think is an exposure to a communicable disease, first you must understand what an “exposure” really is and when it is compensable.

Many workers’ compensation first reports of injury claiming exposure are not really a true exposure to a communicable disease. For example, if a rowdy student spits on a special education teacher and the teacher is sent or requests to go for blood testing, this is not a “true” exposure. Conversely, if the student has a confirmed diagnosis of viral hepatitis and the teacher has been in contact with any of the student’s bodily fluid that contains blood, “true” exposure has occurred. Another example would be if a teacher is bitten by a student and there is blood exposure to either person.

Many workers’ compensation first reports of injury claiming exposure are not really a true exposure to a communicable disease.

Since an exposure is not considered an injury that has resulted in actual damage or harm to the body, the claim will initially be denied. In the event that the exposure does result in the manifestation of the communicable disease in the employee, the exposure will then become an injury and the claim will then become compensable.

According to the guidelines outlined by the Division of Workers’ Compensation Rule 122.3, for an exposure claim to be compensable, the employee must provide a sworn affidavit of the date and circumstances of the exposure.  A blood test must also be performed within 10 days of the exposure, which shall be paid for by the carrier, and must have a negative result.  The employee must also provide you with a copy of the result.  The purpose of testing in this particular timeframe ensures that the employee was free of the disease prior to the exposure. If a follow-up test shows a positive result, then the exposure converts to an actual injury within the course and scope of employment. 

For guidance with these types of claims, please contact Sarita Shipe at 800.482.7276, ext. 7221, or Nancy Kunschik, R.N., at ext. 4303.


Disclaimer: This newsletter is intended for Fund members only and any unauthorized distribution not approved by the Fund is strictly prohibited. The newsletter is for educational purposes only and contains information to facilitate a general understanding of the law. It is not an exhaustive treatment of the law on this subject, nor is it intended to substitute for the advice of an attorney. Consult with your own attorneys to apply these legal principles to specific fact situations.