Long-Haulers May Have Profound Impact on WC System

Sarasota, FL (WorkersCompensation.com) – “I started out January and February a little taken aback because in one week over 10 people called me who had tested positive for COVID in the summer — they are young people in their 30s — and suddenly sitting at their desk working, developed shortness of breath, really severe headaches, and profound — they’ve learned — hypertension. Just out of the blue,” said Teresa Bartlett, MD, senior medical officer for Sedgwick. “They didn’t have particularly severe cases of COVID in the summer.”

That prompted Bartlett to delve into research about the potential long-term effects of COVID-19. A study by the National Institutes of Health involved 57 countries and included more than 4,000 U.S. residents.

“What they found is that 50 percent of the people were unable to work fulltime 6 months after they tested positive for COVID,” Bartlett said. “Only 8 percent of those people actually were hospitalized. So they were not the most severe cases.”

Bartlett joined a panel of workers’ compensation authorities discussing claims development for COVID-19, during an ‘Out Front Ideas with Kimberly and Mark’ webinar. Among the concerns of workers’ compensation stakeholders is the potential for COVID-related claims for symptoms that develop months after a worker has had the virus.  

Long Haulers

Fatigue, difficulty sleeping, and shortness of breath are among the symptoms reported by those who’ve tested positive for the virus in the past. Another is ‘brain fog.’ “Eighty-eight percent of the people [in a study] said they cope with some form of cognitive dysfunction,” Bartlett said. “That is such a difficult thing to deal with and be able to lay your hands around it and define it.”

That study, of published findings on more than 47,000 people who had been infected with COVID, found that 80 percent developed at least one long-term symptom. In addition to such things as attention disorder and hair loss were conditions more concerning to workers’ compensation payers.

“We’re seeing pulmonary embolisms pop up very quickly; we’re seeing cardio myopathies; we’re seeing blood clots in the legs,” Bartlett said. “There’s more we don’t know then what we do know. But we are watching this very closely because we do believe there will be some long-term consequences, especially for those healthcare workers that have been on the front-line day in and day out. [They] may be suffering from PTSD, but they have been so resilient to keep going that when there’s finally a break I’m a little worried about what will happen with these folks. So I think it’s just something we have to be very mindful of in our industry and be prepared for how we will deal with it.”

Latest Data

Trying to keep up with the latest research on the virus is tricky — especially as it relates to workers’ compensation claims. While NCCI and state rating bureaus have data on many jurisdictions, it typically does not include information from self-insured organizations or states with monopolistic systems. Information from healthcare and municipal workers is often not included in the reports.

“The more data sources you can look at and understand where your data may fall, you’ll get a better picture about how your data compares,” said Kimberly George, SVP of Corporate Development, M&A and Healthcare at Sedgwick, and co-host of the webinar. Getting the most up-to-date and accurate data has been challenging.

“Early on, lots of research organizations were scrambling to estimate the size and the full impact of COVID on our individual systems. We were all scrambling to find suitable and stable infection rates, hospital admissions, mortalities and average cost per claim but it just wasn’t available in those early months of April and May. So we were all putting out models that had fantastic ranges,” said Alex Swedlow, president of the California Workers’ Compensation Institute. “Our original estimate I think was between $5 billion and $12 billion. Other research organizations had equally wide projections and those projections just weren’t very useable. It certainly scared a lot of us but the lack of stability of having good elements to model was a big hurdle.”

Researchers now have a better handle on what to look for to make their estimates. In terms of the number of COVID claims, CWCI estimates that through January 2021, there were 123,600; however, once all claims have been reported, the estimate is 143,000. An early drop in total California workers’ compensation claims has largely rebounded. CWCI projects just a 4 percent drop in claims, of which COVID claims make up 20 percent of total claims.

Cost of Claims

While much of the data released indicates many COVID-related claims have been relatively low cost, that ignores many other claims.

“I cringe when I hear the industry saying, ‘well workers’ comp isn’t impacted by COVID, these are claims that wrap up straight away,’ not giving consideration to long haulers and what we will see in the future, but also to what insurers or employers are experiencing,” George said.

Safety National, which provides excess insurance largely to the self-insured market, has seen some significantly high-dollar COVID claims.  

“For our COVID claims where the incurred is over $100,000, 15 percent of those actually have incurred over $1 million,” said Tim Stanger, Safety National’s VP of Partner Relations. “Those claims that are over $1 million are a mix of deaths and extended ICU hospitalizations.”

Stanger cited several claims that incurred more than $2 million. “Very catastrophic situations involving the healthcare sector as one would expect but weird stuff too,” he said.

In one case, a worker underwent a double lung transplant. Another had an 11 week stay in an ICU. A third had extensive life-saving treatment called extracorporeal membrane oxygenation or ECMO and ultimately died. There was also a worker who suffered renal shut down, brain injury from a high fever and ended up as a quadriplegic as a result of COVID-19.

“It’s hard to wrap your mind around how that injury progressed like that but here we are with a quadriplegic employee,” Stanger said. “Over $2 million incurred on each of these claims, which just goes to show you that although a lot of the claims are relatively minor there are some bad ones out there and it’s unfortunate but it’s a reality.”

Sedgwick, which has many self-insured companies in the retail sector, has broken down its COVID-related claims into several buckets in terms of severity:

• Quarantine
• Nominal medical treatment
• Moderately complex
• Severely complex, where the patient is in an ICU
• Fatality

Most of the claims involve little if any medical treatment and/or time away from work. Overall, 73 percent of the COVID claims are valued at less than $5,000, while 85 percent are valued at less than $10,000.

Of the remaining claims, 0.5 percent are fatalities, 1.5 percent involve ICU stays, and 8 percent are considered complex but without ICU stays.

“The 8 percent that are moderately complex are involving about 6 weeks away from work and several medical visits, to the tune of anywhere up to $3,000 to $5,000,” said Max Koonce, chief claims officer at Sedgwick. “[Other than fatalities] the big cost components are the 1.5 percent that are in significant time away from work….really looking at nearly half a year on average; and the medical because it does involve ICU for a prolonged period of time because it is very, very expensive. The ICU is by far, without a doubt, the most expensive, costing well into the tens of thousands of dollars for those particular severe clients.”

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