Workers’ compensation provides medical and monetary benefits for a percentage of lost wages to employees who become sick or injured on the job. The details and regulations vary widely between states; however, workers must typically prove their injury or illness occurred during the course of their employment. For certain illnesses, including COVID-19, this can be particularly challenging.
During the COVID-19 pandemic, several states adopted changes to their regulations to make it easier for certain workers who were required to work outside of their homes and contracted COVID-19 to file a workers’ compensation claim. Due to its widespread transmission, it was difficult for employees to prove an infection was acquired on the job. As a result, states adopted rebuttable presumptions, which shifted the burden to the employers to prove that the employee did not contract COVID-19 in the workplace. A total of 36 states, Washington D.C., and Puerto Rico implemented or considered such changes. Some offer presumptions to a select group of workers, such as frontline healthcare workers and first responders, while others included broader groups required to work outside of the home.
Figures show that workers’ compensation claims for COVID-19 have not yet put a significant strain on the industry although experts warn that this may change with the unknown long-term effects of the disease and the classification of Long COVID as a disability.
Our team had the opportunity to speak with Beth Burry-Jackson, a senior vice president of case management for Sedgwick, about her experience with Long COVID and workers’ compensation. Due to the evolving nature of Long COVID, it presents many challenges around workers’ compensation claims. Highlights from the discussion are shared below.
- An official diagnosis code for Long COVID and workers’ compensation is still undergoing final review, making it difficult to track associated formal claims. Claims for Long COVID will need to consider the collection of symptoms as a whole, rather than a single diagnosis. However, there is a wide range of symptoms which affect individuals differently and many can mirror those caused by other comorbidities. Ms. Burry-Jackson explained the importance of being able to establish the employee’s baseline health status, lingering symptoms, and plan for a return to work for each claim for Long COVID.
- Another challenge is the uncertainty regarding the duration of symptoms and the timeline for the employee’s return to work. There is no set of best practices or a gold standard for treatment, making planning for recovery and returning to work unpredictable. Additionally, an employee’s return may not be 100 percent and they may require accommodations, such as modified schedules, to meet their needs.
- Testing limitations and the timing of COVID-19 diagnoses may also present complications. Some individuals who are experiencing Long COVID symptoms may not have documentation of a positive test for their initial COVID-19 infection, either due to the lack of available testing at the beginning of the pandemic or potentially from asymptomatic or mild infections for which they were never tested. As a result, Ms. Burry-Jackson explained how these individuals will have an additional burden of not only linking their current symptoms to COVID-19 but also tracing their initial infection back to employment for a workers’ compensation claim (either requiring contact tracing or relying on presumptive clauses in certain states). This may be especially difficult without a positive test confirming the date of infection. Even if the state offers a presumptive clause for their job description, they will need to look at the state requirements for the Long COVID diagnosis. Some states will require a positive COVID-19 test, while others may accept a physician’s diagnosis. Therefore, testing documentation will be an important factor in workers’ compensation claims for Long COVID.
- Another unique aspect: Long COVID often has a mental health component that may require short or long term treatment. As we learned from our conversation with Ms. Burry-Jackson, regulations regarding coverage of mental health claims for workers’ compensation can vary widely between states. Thus, the ability for an employee to receive benefits for their mental health symptoms may depend on the state.
In addition to the issues surfacing around Long COVID and workers’ compensation, experts are concerned about the large and unprecedented strain on the healthcare system due to the wide range of symptoms and potential prolonged duration of treatment. It is still early in our understanding of Long COVID and there remains much to learn about the condition itself as well as its effect on the healthcare system, workforce, and workers’ compensation.
More of Ms. Burry-Jackson’s insights on Long COVID and workers’ compensation have been featured in Business Insurance (see here and here).
We closed the conversation with Ms. Burry-Jackson sharing information about organizations where individuals can learn more about the topic:
The Long COVID Initiative team thanks Beth Burry-Jackson for her work on Long COVID and workers’ compensation and for sharing her expertise with us.