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What You Need to Know about Exposure Claims

September 07, 2017 Sarita Shipe

Workers' Compensation

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.

What constitutes exposure?

The Texas Health and Safety Code defines a communicable disease as “an illness that occurs through the transmission of an infectious agent or its toxic products from a reservoir to a susceptible host, either directly, as from an infected person or animal, or indirectly through an intermediate plant or animal host, a vector, or the inanimate environment.”

Reportable communicable diseases include:

  • Acquired immune deficiency syndrome (AIDS);
  • Botulism--adult and infant;
  • Cholera;
  • Encephalitis;
  • Lyme disease;
  • Malaria;
  • Measles;
  • Meningitis;
  • Tetanus;
  • Tuberculosis;
  • Yellow fever, and many more.

Given the definition, many workers’ compensation first reports of injury claiming exposure are not really a true exposure to a communicable disease. For example, a rowdy student spitting on a special education teacher may not constitute a true exposure by itself. However, 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, then true exposure has occurred.

When is a claim compensable?

If 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.

Editor's note: This article was originally published in June 2011 and has been updated for accuracy and comprehensiveness.

Tagged: claims