Long-COVID cases among workers who contracted the coronavirus on the job are making life complicated for insurers as the workers continue requiring treatment and doctors’ visits indefinitely.
In California, insurers are required to extend workers’ compensation benefits to anyone who is deemed to have contracted COVID-19 at work.
The concern for insurers and self-insured employers is that once a claim is accepted as a compensable workplace condition, they can be on the hook for medical costs long after initial medical treatment.
And because COVID-19 is a new disease, insurers and self-insured employers can’t accurately predict how long these claims may last. With long COVID, the tail of the claims could be years.
In some cases, long COVID — also known as post-acute COVID-19 syndrome — has led to disabilities and other impairments. If a condition is related to the original claim, workers’ comp carriers are required to cover continuing treatment and medication costs.
To complicate matters further, the Office for Civil Rights of the Department of Health and Human Services and the Civil Rights Division of the Department of Justice in 2021 released joint guidance indicating that long-haul COVID should be treated as a disability related to the condition.
Long COVID explained
Some people who contract COVID-19, even those who initially have mild or no systems, can develop a number of long-term conditions well after the virus has cleared the system and they are no longer testing positive.
Long COVID can last for weeks or months after initial infection. Some people have been dealing with it for more two years since they originally were infected.
Long-COVID symptoms can range from mild to severe and some people sustain organ damage, which may lead to health complications that linger after the initial infection has waned. That may include long-term breathing problems, heart complications, chronic kidney impairment, stroke and Guillain-Barre syndrome — a condition that causes temporary paralysis.
There is evidence that some long-COVID sufferers develop symptoms akin to chronic fatigue syndrome, a complex disorder characterized by extreme fatigue that worsens with physical or mental activity, but doesn’t improve with rest.
Health effects that have been associated with long-haul COVID include:
- Fatigue
- Shortness of breath or difficulty breathing
- Cough
- Joint pain
- Chest pain
- Memory, concentration or sleep problems
- Muscle pain or headache
- Fast or pounding heartbeat
- Loss of smell or taste
- Depression or anxiety
- Fever
- Dizziness when you stand
- Worsened symptoms after physical or mental activities.
Claims fallout
Typical workers’ compensation claims do not have these types of long-term symptoms.
Because symptoms can vary from person to person and for varying lengths of time, workers’ compensation claims payers are wrestling with how much they need to set aside for long-COVID claims, which they are required to do under law for all claims. If they underestimate, they’ll need to add more funds to the reserves for the claims.
It should be noted that these lengthy cases are relatively rare. The vast majority of COVID-19 workers’ comp cases are very small, particularly when an employee didn’t need hospitalization and missed some time from work quarantining and recovering.
One report in the U.K. said various studies’ estimates of the percentage of patients who develop long COVID range from 2.3% to 37% of COVID-19 patients.
The Workers’ Compensation Insurance Rating Bureau of California estimates that COVID-19 workers’ compensation claims in the state will ultimately cost insurers $1.2 billion.
The takeaway
The good news for employers in California is that those claims do not count against their experience rating, meaning COVID-19 claims won’t affect their rates. At the same time, however, the cost of COVID-19 can carry over beyond workers’ compensation as absences create production difficulties.
If you have more questions about health insurance for your small business, contact us today. We’re been helping small businesses since 1938 and would love to help you. Contact Shannon Wolford at shannon@visualmediaalliance.org or 415-710-0568.