Long COVID–the Challenge of Managing Claims for a Condition with Limited Scientific Data

MARVALEE HARRIS:  No, because it's anything beyond the four weeks.  Some people may not develop those symptoms for several weeks after.  So I think as long as it falls beyond that four-week mark they're considering it as long COVID.  

>> So I'm still at risk for it since I got COVID and I haven't had anything.  

>> How about hearing loss, has that shown up?  

MARVALEE HARRIS:  I have not seen any claims with it.  But, remember, the CDC will plays some of these reported symptoms on their -- on the list based on I guess the in facts they're reported.  Or they put in the more common ones people are reporting but there are a slew of other symptoms that, you know, quite possibly could be related to post COVID.  

Because COVID causes a lot of inflammation, something like that could potentially be an issue or something that's sequalae of COVID-19.  

>> The last question I have -- I know two people that they think it was caused by COVID, two of them, so I don't know if it's shown up or not.  Are the different variants having different constellations of long COVID symptoms?  

MARVALEE HARRIS:  I think that's going to be based on research studies that are still underway.  I think regardless of whether -- you know, like the initial COVID onset and then we had the Delta variant and numerous other variants.  I think they will have to do -- when I say "they" researchers are going to have to do studies and maybe there might be a study that outlines which particular variant or variants cause more of one thing.  I do know that with Omicron." 

The COVID-19 symptoms were slightly different than original onset.  Original onset people reported loss of taste and smell but with Omicron people were having headaches, fever, things like that.  I think there is a lot of research going on and Morissa sent us an article where it looks like in the science world there really hasn't been too much done in regards to long COVID.  

>> If I'm seeing two issues and Corey you can go on but the two issues I see are one the person has to identify this is because I had COVID and the second thing is they have to find out that it affected their work and then they have to apply for it.  But originally they have to be able to identify it as having come from COVID and I see that as the hardest one of all the three steps in this process. 

COREY WELCH:  From a lay perspective I would say it's hard because many of the care providers are not totally up to speed on this either in terms of linking the two together.  So many body systems are impacted or can be as Dr. Harris mentioned and in appeals we're seeing all kinds of stuff linked to for otherwise inexplicable no other cause for it ask and they had COVID and this is going on.  Nothing would surprise me, any symptom constellation post COVID, no other explanation for it, I would suspect it to be long COVID.  

>> Lucky for us it doesn't require a cause, it just affects their ability to work.  So it doesn't really matter but I have known clients that wanted to identify that.  

MORISSA FREGEAU:  Yeah and I think that's really important to know that under the ADA it's just how you function, what you can do and whether your activities of daily living or your work environment is impacted. And even from an ERISA perspective I think that we've seen with other conditions that we can relate back to long COVID, chronic fatigue syndrome when it was first -- when it first came to be in courts.  
It was looked at, well, this is just a totally subjective condition and over time the courts have looked at it differently in terms of how is it reported?  What is the actual symptoms?  So I think you're right it doesn't actually matter whether it comes from COVID, but I think we're going to learn a lot in the next ten years and we have yet to learn it.  

COREY WELCH:  That's true from the claims perspective as well.  COVID -- post-COVID can be an explanation for a whole bunch of stuff that otherwise can't be explained.  You could point to something and say they had COVID and loss can be measured.  

>> It certainly can be measured and as I said I know two people that have had that claim inform and that was sort of interesting, that I had not seen that in the literature but maybe it's showing up more than people recognize because it has to really come on pretty hard before they think of the relationship.  Anyway I thought I would ask those questions.  

COREY WELCH:  Thank you. 

MORISSA FREGEAU:  Thank you.  Does anybody else have any questions they would like to ask?  

COREY WELCH:  Interestingly I will throw in from the mental health perspective people who had a critical illness experience with COVID are coming back with PTSD symptoms because it is life-threatening.  We obviously know how many people have died.  A survivor from a critical illness episode of COVID could very well be experiencing PTSD.  That's something we need to be aware of in the claims environment.  

MORISSA FREGEAU:  So we have for you when you get the deck, some references that Dr. Harris used for medical references and all of my legal references, the cases and the sections of federal law that I mentioned.  So I will -- sorry, that was not what I wanted to do.  Here we go.  Now I'm good.  So any other questions that anybody has?  Thank you so much for coming this afternoon.  This is my second time speaking at the NFB and I think it's important to have these discussions and I enjoy coming every year.  

COREY WELCH:  We have a question in the chat.  Has the Social Security Administration informal acknowledged long COVID?  

MORISSA FREGEAU:  The FAQs that I sent have been part of the questions which usually the SSA and the DOL and HHS put all those questions together.  Yes, they have.  I have not looked at any cases under SSDI to see how they're -- whether individuals are getting on claim or not with SSDI but in terms of the FAQs, the ones that are issued by the D OL and HHS usually apply to SSDI. 

>> But we have the option of claiming the condition as the diagnoses rather than the cause which may very well get it to SSI or SSDI if we can -- if a condition is well defined even if we don't know how it happened, isn't that how you play that out?  


>> For those of us that do this we know how to play these games because cause and effect is hard to show but diagnoses and conditions are easier to show.  I'm sorry, those of us that do this do this allot. 

COREY WELCH:  Excellent point. 

MORISSA FREGEAU:  We totally agree with you.  Even for those of us in corporate America somebody who has done that and laid it out it's easier for us, too.  When I do ADA accommodations I try to avoid diagnoses because I don't want them to look it up on the internet and it says here if you have this you should be able to do that.  Everything is personalized.  There is no way we should possibly let that happen so I don't even put diagnoses I put generic stuff like has a neurological condition or metabolism issue, nothing that they could look up on the Internet but I can only do that for ADA, the others require a diagnoses.  

MORISSA FREGEAU:  Yeah, under the ADA you're actually not supposed to get a diagnoses, only the conditions that need an accommodation or -- anyway, but, yes, it doesn't always work in a group insurance. Thank you.  Thank you so much for coming.  We appreciate your participation.  We appreciate you attending.  Hopefully we will see you in other sessions, thank you.  Hopefully we will see you next year in person.  

>> I have one more question, worker's comp requires cause if someone is exposed at work and got sick that's an example of where cause and effect is important.  Has any of that worked its way through the system yet?  

MORISSA FREGEAU:  I have not seen any particular cases that I've looked at but I could see that it's something that based on the fact that it's a pandemic that it's hard to prove but I'm guessing we will see those types of cases especially from hospitals and factories and individuals that more than likely got it at work but I have not seen -- I have not looked specifically for those types of cases.  

>> I mean, it's hard.  You talk about chicken farms.  Chicken processing plants. 

COREY WELCH:  Exactly. 

>> People were not able to say they were sick, they had to keep going to work, they were considered essential work and low and behold they had COVID outbreaks.  This is in my backyard I have a friend who is a vet who works at one of the meat packing plants and she didn't get COVID that she knows of but they're incubators but I have not seen it come in as a worker's comp claim and it will be interesting to see how it comes down.  I've not been asked to do that.  I do federal are worker's comp and she is a federal employer, could come down, but she has not caught COVID yet.  I'm just saying this is going to be happening.  It's a matter of time before somebody starts claiming it. 

MORISSA FREGEAU:  Absolutely, absolutely. 

COREY WELCH:  I wish I knew more about how worker's comp carriers are treating these COVID diagnoses when somebody in that situation was not allowed to work from home.  Had to go to the plant.  Contracted COVID.  There is somewhat cause and effect from a disability perspective. 

>> On has anybody seen any of the data for worker's comp yet?  

MORISSA FREGEAU:  The cases are just coming out now so it's just that I didn't do any research on them. 

>> We'll see.  Federal worker’s comp I would have -- I mean, I have not had any cases like that come in.  I do not do state.  Somebody has a state one I will give them to somebody else but federal it will be interesting because that's cause and effect, none of the others require that but that requires it.  


>> It will be harder to show.  I'm not sure how that's going to play out.  

MORISSA FREGEAU:  Yeah.  I agree.  Well thank you everybody.  We appreciate all the dialogue.