In the middle of March, Megan Harring began to feel sick.

It was early in the COVID-19 pandemic, when personal protective equipment was in short supply and few in Oregon could get tested for the virus.

Harring, 33, is a registered labor and delivery nurse at Providence's Hood River Hospital. After she developed a fever, nausea, a splitting headache and shortness of breath, her doctor suggested going to Seattle for a drive-thru coronavirus test. That was impractical for the mother of two young children.

Harring was so sick she missed a month of work. In mid-April, she finally got a test—it was positive. On her doctor's advice, she filed a workers' compensation claim.

Workers' compensation insurance is a state-regulated system designed to reimburse workers who have gotten ill or injured at their workplace, paying for their medical expenses and lost pay. All employers in Oregon must, by law, purchase insurance for their employees, or self-insure.

Providence Health & Services—the health care giant with more than $20 billion in annual revenues, 51 hospitals, more than 1,000 clinics, and 120,000 employees across seven states—is a self-insurer. Therefore, Providence can decide whether to approve workers' comp claims or deny them. In the case of Harring, the nonprofit denied her claim, telling her in a May 1 letter she'd failed to produce sufficient evidence she'd gotten sick at work.

"They said, 'Do you have proof of contact?'" Harring recalls. "How could I? Nobody was being tested."

Harring is not alone. In Oregon, Providence has denied a far higher percentage of workers' comp claims since COVID erupted than any other employer or insurer, including SAIF, the state-owned insurer that dominates the market.

Indeed, state data shows that most workers' compensation claims filed for COVID-19 are approved. As of July 10, workers' comp insurers had approved 74% of the 557 claims filed.

Providence was the outlier, according to the state statistics, rejecting 41 of 44 claims at that time, denying 93 percent. (SAIF's denial rate was 13 percent.)

A state panel grilled Rich Reynolds, Providence's senior manager of workers' compensation, at a July 15 hearing.

Reynolds told the committee that Providence investigated all workers' comp claims thoroughly but fairly and paid for testing and quarantine time even when it denied claims. Pressed why Providence's denial rate was so much higher than other insurers', Reynolds said, "It might be too soon to draw any conclusions."

For the past month, at Gov. Kate Brown's request, a state panel called the Oregon Management-Labor Advisory Committee, or MLAC, has grappled with an important question for frontline workers like Harring: Should people who work in jobs with a high risk of coronavirus infection and then test positive for the virus be presumed to have gotten infected on the job?

If so, frontline workers who contracted the virus couldn't be denied coverage by their employer, and would have their medical bills paid and lost wages compensated. If not, they could have to pay their own medical bills and use sick leave and vacation to recover.

Many business owners say the current rules, in which employees must prove their injury or illness originated in the workplace, are highly effective. They say "presumptive coverage" is too broad and would place a financial burden on employers.

"We've got a workers' compensation system that works very well," says Sandra McDonough, president and CEO of Oregon Business & Industry. "If somebody got COVID-19 in the workplace, it should already be covered."

"The presumption that working Oregonians who have COVID-19 could only have been exposed at work risks the stability and balance of the workers' compensation system," Portland Business Alliance CEO Andrew Hoan told MLAC in a July 15 letter. "The data we have heard supports that the system is working as intended. A presumption of compensability for COVID-19 is not needed."

But organized labor points to denials of claims like Harring's as proof COVID-19 is different. There are still too many uncertainties, including asymptomatic spread, and too few tests available for employees to provide the kind of proof some insurance claim adjusters require. And, as the state's case count has risen, contact tracing has proven less effective. That makes it even harder to determine how someone got the virus.

Advocates say Oregon should offer presumptive coverage for certain high-risk professions—such as health care workers, first responders, custodians, and food industry workers. Felisa Hagins, a lobbyist for Service Employees International Union Local 49, notes that data shows low-income people of color who work as custodians, security guards, retail clerks and laundry staff, and in the agricultural industry are disproportionately affected by COVID-19.

Politicians and employers routinely tout the heroism of these frontline workers. But many of those heroes, Hagins says, have poor or no health insurance, cannot afford to take time off if they get sick, and may not know they are eligible for workers' compensation.

"It's important for the Legislature to live up to our obligation to these workers," Hagins says. "When you look at the numbers of all workers who are getting COVID as a function of keeping our economy going, that says to me that presumptive coverage is necessary."

Kevin Mealy, a spokesman for the Oregon Nurses Association, points to the example of Providence, Harring's employer, as evidence the system isn't working.

"More than 10% of Oregon's COVID-19 cases are health care workers," Mealy says. "We're asking Providence to do the right thing and protect people, not profits. Presumption must be the standard for the nurses and other frontline workers we rely on."

As for Harring, she's returned to work and the gym, but nearly four months after she first fell ill, she still feels short of breath during what used to be a routine workout. She's appealing the denial of her workers' comp claim. But whatever happens, with COVID-19 increasing its grip on Oregon, she'd like to see more protection for her colleagues on the front lines.

"We put ourselves out there every day, no matter what," Harring says. "And we're just at a higher risk of getting infected."

Sidebar: Prior Presumption

The concept of presumptive insurance coverage is not unique to COVID-19. Firefighters, in particular, have successfully made the case in the Oregon Legislature that they should get presumptive compensation for respiratory diseases. Other first responders, like police officers and paramedics, get presumptive coverage for post-traumatic stress.

So far, 17 states have enacted some version of COVID-19 presumption since the pandemic began, according to the National Conference of State Legislatures. Some states, such as New Hampshire, have drawn their laws narrowly, benefiting just first responders. Other states, such as Colorado and Illinois, have provided workers' compensation protection to "all essential workers."

Correction: This story originally said Providence had denied more claims than any insurer. In fact, SAIF has denied more but Providence's denial rate is much higher. WW regrets the error.