COVID-19 and Workers’ Comp: NCCI Looks at the Catastrophic Cases We’ve Seen So Far

A recent NCCI article looks at outlier COVID-19 claims and what they could mean for workers' comp.
By: | November 6, 2020

If there’s one thing the COVID-19 pandemic has brought, it’s uncertainty. The virus rattled markets, shut down cities, and sent workplaces remote — if they could remain open at all.

In the workers’ comp arena, payers and state governments debated whether COVID-19 was a compensable disease.

Payers noted that in many cases it’s impossible to prove whether or not a worker contracted the virus at work while states passed presumption laws protecting essential workers.

Added to these uncertainties is the variance of the virus’s effects, which seem to express themselves differently from person to person.

A recent NCCI article, “Catastrophic COVID-19 Workers’ Compensation Claims — Case Studies and the Pandemic” by Paradigm’s Chief Medical Officer and Senior Vice President Dr. Michael Choo looks at outlier COVID-19 claims and dissects what they could mean for the industry.

COVID-19’s Effects on Workers’ Comp: By the Numbers

At the beginning of the pandemic, the industry prepared for an onslaught of COVID-19 claims that has yet to materialize. Here’s a look at the numbers so far:

  • Payers have seen a significant decrease in non-COVID claims 25-50% since early March and payers expect total claims to decrease by about 20% for the year.
  • COVID-19 claims are likely to be inexpensive. In a survey, one payer reported that 96% of COVID claims cost less than $3,500.
  • While only 5% of COVID-19 patients become critically ill, the death rate among these patients remains high. Currently, the mortality rate of critically ill patients is around 30.9%, down from a previous high of 66%.

COVID-19 cases may be the minority of workers’ comp claims, but it’s still important for workers’ comp payers to prepare for severe cases. Complex and catastrophic COVID cases are rare in workers’ comp, but a look at outlier cases in the industry reveals that there’s no predicting the trajectory of this disease.
In his NCCI article, Choo looks at two such outlier cases and their implications for the industry.

Case 1: Neurological Complications

The first case Choo details involved a 31-year-old worker who had no previous medical conditions and no history of drug or tobacco use.

In this case, the worker contracted COVID-19 at work and then experienced headaches, body aches and a fever. His symptoms progressed until he had shortness of breath, nausea, fatigue and difficulty walking. Later, he reported numbness on his right side, difficulty speaking and weakness.

The worker was diagnosed with COVID-related pneumonia and a moderate-sized acute stroke. He spent 30 days in the hospital and was placed on a ventilator. Since being released from the hospital, he has undergone both speech therapy and physical therapy and has used a wheelchair.

Given this worker’s age and his lack of pre-existing medical conditions, workers’ comp payers and care providers may have expected him to bounce back quickly from the disease.

COVID-related, long-term conditions is something the workers’ comp industry needs to prepare itself for, even in young, previously health workers who contract the disease.

Case 2: Organ Failure

The second case Choo analyzed involved a 27-year-old worker who was a former smoker and who had been diagnosed with Lupus. Her Lupus had caused some kidney impairment and she had been diagnosed with Lupus Nephritis, and as a result had developed chronic renal insufficiency.

Her COVID-19 symptoms progressed rapidly from nausea, vomiting, and diarrhea to fever, cough, and shortness of breath. In the hospital, she required emergent resuscitation due to respiratory failure, hypertensive crisis, and anemia.

She was intubated and placed on a ventilator and spent 27 days in the hospital. Her renal and kidney function worsened as a result of her illness. In the future, she may need dialysis or a kidney transplant.

Like the worker in the first case, she was young, but her comorbidities likely played a role in her illness as COVID-19 accelerated the damage to her kidneys. Payers need to be prepared for increased complications in workers with comorbidities who may contract the virus.

More data is needed, Choo concluded, before the financial effects of the virus on the workers’ comp industry are known.

But payers should be wary of believing that COVID-19 claims will likely be asymptomatic and inexpensive. This disease has the potential to bring in catastrophic claims with long-term disability. &

Courtney DuChene is a freelance journalist based in Philadelphia. She can be reached at [email protected].

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