COVID19 | Global Risk

CA SB 1159 COVID-19 Form

Covid-19 CA SB 1159 Form

Choose all that apply:

COVID-19 exposure occured on or after 09/17/2020 (must be reported to carrier within 3 days of knowledge of exposure)

COVID-19 exposure occured between 07/06/2020 and 09/16/2020 (must be reported to carrier by 10/17/2020)

A workers' compensation claim has been filed because of this COVID-19 exposure

A workers' compensation claim will be filed because of this COVID-19 exposure

Have any of the locations where the employee worked been ordered closed by the local health department, the State Department of Public Health, the Division of Occupational Safety & Health, a school superintendent, etc., due to the risk of infection by COVID-19?

Yes

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Thank you for submitting. Please be advised that we have gathered information relevant to COVID-19 and its impact to workers’ compensation claims and your businesses. These materials do not constitute legal advice, nor should any of the information that we provide be construed as legal advice. Furthermore, the information we have provided does not include all relevant information and should not be used as the basis for legal, claim benefits, safety, or human resource-related decisions. Please seek legal advice from an attorney with expertise in the relevant subject areas and state law regarding whether a COVID-19 related claim is compensable under a specific state’s law.

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