Long-Haul COVID and Its Toll on Workers’ Compensation

The COVID-19 global pandemic has had an enormous impact on workers’ compensation, including long-term disability and mental health implications. And while many states currently have presumptions that allow employees who contract COVID-19 to claim workers’ compensation benefits, workers who develop long-haul COVID symptoms, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), often have a greater impact on the workers’ compensation system. For some, PASC symptoms endure for weeks or months after the initial infection and can include fatigue, headache, respiratory issues, neurological challenges, cardiovascular problems, musculoskeletal pain, depression and anxiety. Other PASC sufferers, however, may improve after several weeks only to relapse thereafter or present with new symptoms. Interestingly, a patient’s COVID-19 severity is not a factor in their likelihood of developing PASC. A UC Davis Health article reports on a study that determined 31.3% of patients hospitalized with COVID-19 developed PASC, as did 32.7% of COVID-19 outpatients.

According to the American Academy of Physical Medicine and Rehabilitation Multidisciplinary PASC Collaborative, PASC includes lingering symptoms that fall into the following six symptom groups: cardiovascular, pulmonary, endocrine, autoimmune, mood disorders and sleep disorders. While studies performed early in the pandemic determined that 5% of those who contract COVID-19 would develop PASC, more recent estimates contend that 10% of those with mild COVID-19 will see symptoms linger more than four weeks after onset. Yet, as the pandemic continues, researchers fear that this number may be as much as 20% underestimated. This creates implications for the workers’ compensation industry.

For example, California workers’ compensation covers contagious respiratory illnesses, including COVID-19; therefore, California employees exposed to COVID-19 have the right to file a workers’ compensation claim. However, there is a rebuttable presumption. If the employer wishes to challenge an employee’s claim, the burden of proof is on the employer to prove the claimant was not exposed to COVID-19 in the workplace. The Workers’ Compensation Insurance Rating Bureau of California  (WCIRB) estimates that COVID claims could cost the state of California workers’ compensation system approximately $2.2 billion to $33.6 billion annually.

There is no standard approach to COVID-19 coverage in the workers’ compensation industry. The National Conference of State Legislatures reports that since the start of the pandemic, 28 states and Puerto Rico have included COVID-19 as a work-related illness covered by workers’ compensation, and 11 states have authorized legislation that includes a presumption of coverage for varied workers. In addition, Utah and Wisconsin have specified that COVID-19 coverage extends to only First Responders and health care workers; Illinois, New Jersey and Vermont have coverage that includes all essential workers, and California and Wyoming coverage includes all workers. Still, some states included presumption policies in their COVID-19 emergency response but have discontinued these policies following the end of the initial state of emergency.

Contributing to the physical problems that PASC causes are the mental health issues that often affect long-haul sufferers. A May 2021 study found that six months after contracting COVID-19, one-third of patients had been diagnosed with anxiety, depression and PTSD, all of which place additional demands on the workers’ compensation industry. Dr. Hiren Ghayal, a psychologist with Ascellus Behavioral Health states: “I have identified trends consistent with long-term COVID, which include having a fear of being ill, isolated/feeling lonely, financial stressors due to missing extended periods of time at work and substance abuse.” Concurring with Dr. Ghayal’s statement is recent evidence that points to a rise in substance abuse, especially alcohol consumption, occurring since the pandemic’s onset. The American Psychological Association reports that four months into the pandemic saw a 13% increase in substance use, which accompanied an increase in substance overdoses, up 18% from the previous year. This trend continued through the end of 2020, with 40 states reporting increases in opioid-related deaths.

Despite these staggering statistics, the good news is that early intervention and cognitive behavioral therapy can effectively treat the psychological issues associated with PASC. Ascellus’s evidence-based programs have proven successful in helping workers regain important aspects of their health and empowering workers with tools that help prevent loneliness, fear and stress from taking control and worsening their physical symptoms.