Long Covid and Workers’ Compensation

NCCI’s latest research report takes a deep dive into data and trends in long COVID for those covered by workers’ compensation. The study, Long COVID in Workers Compensation: A First Look, covers COVID-19 workers’ compensation claims with accident dates between the first quarter of 2020 and June 2021 and medical services provided through March 2022. It includes 7,651 COVID-19 claims with payments of more than $120 million.

The report uses data from NCCI’s new Indemnity Data Call and NCCI’s Medical Data Call. Both include data reported by all workers’ compensation carriers that write at least 1% of the market share in any one state for which NCCI collects indemnity and medical data.

Collectively, these two data sources provide NCCI with expanded means to research impactful forces affecting the workers’ compensation system, including something as significant and unprecedented as COVID-19.

A Frontline Pandemic

It’s been nearly two years since COVID-19 took the world by storm. And, as of July 2022, the United States had nearly 50 million confirmed cases of COVID-19 infections and more than one million deaths.

While the pandemic impacted a wide cross-section of people across the country, frontline workers experienced the brunt of work-related COVID-19, along with long COVID claims.

In terms of gender distribution, in the non-hospitalized long COVID group, females outnumbered males by almost four to one. Females were also over-represented in the hospitalized cohort, although to a lesser extent. This can be explained due to women making up a high percentage of occupational groups with the highest claims, including hospital-professional employees and retirement living centers-health care employees.

Symptoms of long COVID evolve over time. And while the top two concerns—pulmonary and cardiovascular issues—decreased from the first 30 days to the last 30 days, they were offset by an increase in neurological, mood, systemic, and sleep dysfunction symptoms.

More Key Takeaways

NCCI’s long COVID study also revealed the following insights:

• The percentage of COVID-19 claims with long COVID (infected individuals who subsequently endured persistent, debilitating symptoms for weeks and months after initial infection, regardless of the severity of illness originally experienced, whether mild or severe) in workers’ compensation was 24%.
• Twenty percent of non-hospitalized and 47% of hospitalized COVID-19 workers’ compensation patients developed long COVID.
• Hospitalized patients who developed long COVID took longer for such symptoms to resolve compared to patients who were not admitted to the hospital.
• Hospitalized patients sought more physical medical services in the 30- to 270-day PASC window than non-hospitalized patients. (The National Institutes of Health assigned the term “post-acute sequelae1 of SARS-CoV-2 infection (PASC)” to enable research initiatives to better understand etiology and optimal treatment approaches for the prolonged constellation of symptoms beyond the acute COVID-19 infection period. While there is no standardized or universal definition of long COVID or PASC, the Centers for Disease Control and Prevention characterizes it as “an umbrella term for the wide range of health consequences that are present four or more weeks after infection with SARS-CoV-2.”)
• Home health care services performed in the 30- to 270-day PASC window were among the top three medical services provided for patients who had been hospitalized.
• Prescriptions for pulmonary inhalers dominated both the hospitalized and non-hospitalized cohorts.
• The average temporary disability indemnity benefit duration for long COVID patients was about 160 days for hospitalized patients and 95 days for non-hospitalized patients.

The Cost of COVID

When analyzing the numbers, hospital inpatient (HIP) costs made up most of the medical costs for COVID-19 patients. For patients with no long COVID symptoms, 73% of total medical costs were attributed to HIP care. For patients who developed long COVID symptoms, HIP costs comprised 61% of all medical costs.

As far as the breakdown by claims:

• Hospitalized long COVID claims had the highest severity of any of the cohorts, at just over $216k per claim, with about 80% of total claim costs going toward medical benefits.
• Total incurred for non-hospitalized long COVID claims was nearly $40k, roughly split evenly between indemnity and medical.
• For hospitalized No Long COVID claims, the incurred severity was just over $53k, with more than 85% going toward medical.
• Non-hospitalized No Long COVID claims represented the smallest incurred severity of the various cohorts, at less than $7k per claim.
• Almost two thirds of No Long COVID claims were closed within six months of the accident date.
• The corresponding share for Long COVID claims was less than half of that, at 29%. The higher rate of claim closures for No Long COVID claims is expected. Because many of these claims did not incur medical treatment for symptoms related to long COVID more than 30 days after discharge or accident date, a lower severity of illness and increased likelihood for claim closure is indicated.

Final Remarks

NCCI’s initial analysis of long COVID shows these claims are impacting the workers’ compensation industry, but the ultimate consequence or outcome in disability and costs remains uncertain. Since the research was limited to data collected through the first quarter of 2022, the impact of the more infectious or contagious Omicron variant of COVID-19 on long COVID in 2022 also remains unknown at this time.

However, NCCI feels encouraged and reassured by the progress that has been made toward prevention and more effective treatments for COVID-19 infections.