Long COVID continues to plague, puzzle comp industry

As information about long COVID evolves, workers compensation experts are watching how clinical changes and statistics may impact compensability for workers who continue to struggle with the disease’s effects.

Last week, the Workers’ Compensation Insurance Rating Bureau of California released data showing that in 2020 and 2021, comp claims involving treatment for long COVID symptoms were four times more likely to result in permanent disability benefits than other COVID-19 claims.

The report also showed that over a 12-month, post-acute care period, about 13% of COVID-19 claims with medical payments included treatment for long COVID symptoms.

As the comp industry has struggled with defining the illness, findings published on May 25 in the Journal of the American Medical Association narrowed to 12 the most common symptoms associated with long COVID.

“There are still a lot of unknowns out there to see if that [the AMA findings] would affect workers comp in a way that’s more meaningful, but I would expect from a compensable perspective it won’t change too much, especially in those states that adopted the presumptive rules for COVID causation,” said Dr. Kenji Saito, Augusta, Maine-based president of the American College of Occupational and Environmental Medicine.

The AMA study had limitations, and the authors cautioned that the 12 symptoms – which include post-exertional malaise, fatigue, brain fog and dizziness – shouldn’t be considered exhaustive.

Dr. Michael Choo, chief medical officer of Walnut Creek, California-based medical management service company Paradigm Corp., said that while the workers comp sector is eyeing clinical definition changes regarding long COVID, post-infection symptoms for viruses have been around for years.

In the 1990s, chronic fatigue syndrome was diagnosed in connection with infections such as mononucleosis and Lyme disease, as patients experienced secondary post-infection symptoms.

“This is not new in the medical industry,” Dr. Choo said. “It’s always been around where people would experience long-term symptoms. But it didn’t happen very frequently, so it was really not well known except to the specialists.”

Post-infection symptoms became more evident with COVID-19, he said, because of the sheer volume of people infected.

This, in turn, created issues and raised questions surrounding compensability for workers who contracted the virus on the job.

“We opened the doors for all these post-infection sequelae to be considered as a potential workers compensation claim-related issue,” Dr. Choo said.

Workers whose COVID-19 diagnoses are covered as a presumptive occupational injury will likely also be covered if they develop long COVID, he said.

Compensability for long COVID becomes problematic when insurers and employers question whether a worker contracted COVID-19 at work.

“It poses a lot of interesting questions and challenges, legally and clinically,” Dr. Choo said.

Given long COVID is now considered a disability under the federal Americans with Disabilities Act, employers must accommodate. What that looks like is puzzling, according to disability experts.

One suggestion is to permit a worker to work remotely if feasible, said Bryon Bass, CEO of the San Diego-based Disability Management Employer Coalition.

“Recommendations were gathered from an industry think tank to help employers foster an accommodation culture that minimizes the long-term effects of long COVID on the employee and employer as well as the community at large,” he said.

This article was first published in Business Insurance.

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